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HomeMy WebLinkAboutBid Related - Public WorksGRANT COUNTY PUBLIC WORKS DEPARTMENT Sam Castro C.P.O. Ephrata (509)754-6082 ,,rr►► �y� Sam Dart j a Assistant Dir. Of Public Works v Ephrata (509) 754-6082 Keith M. Elefson P.E. - - CountyRoadEngineer Ephrata (509) 754-6082 Bob Bersanti Design/Construction Engineer Ephrata (509) 754-6082 l Jason Collings, Supervisor Solid Waste JRA O SOS E7 Ephrata (509) 754-4319 � � � ,,,,.,,,,� q 11/i'�l4N1N PROPOSAL FOR BIDDING PURPOSES For Construction of: 3 -NE ROAD PHASE 2 RECONSTRUCTION PROJECT CRP 19-08 STPR-P130(006) Sealed Bids will be opened on August 11, 2020 at 1:30 P.M. at the Office of the Board of County Commissioners Commissioners Hearing Room P.O. Box 37 35 C Street NW Ephrata, Washington 98823 Ed Lowry Supervisor Road -District #1 Ephrata(509)754-6586 Mike Detrolio, Supervisor Road District #2 Moses Lake (509) 765-41752 John Brissey, Supervisor Road District #3 Quincy (509) 787-2321 Andrew Booth, Supervisor Bridges Ephrata (509) 754-6082 PROPOSAL To: Board of County Commissioners Date: // 2020 Grant County, Washington This certifies that the undersigned has examined the location of 3 -NE ROAD PHASE 2 RECONSTRUCTION PROJECT, CRP 19-08, In Grant County, Washington, and that the plans, specifications and contract governing the work embraced in the improvement and the method by which payment will be made for said work is understood. The undersigned hereby proposes to undertake and complete the work embraced in this improvement, or as much thereof as can be completed with the money available in accordance with said plans, specifications and contract and at the following schedule of rates and prices. 3 -NE ROAD PHASE 2 RECONSTRUCTION PROJECT Note: Unit prices for all items, all extensions, and total amount must be shown. Please type or use ink. Please initial all changes. Item Plan Item Description j Price per Unit' Total Amount No. Quantity Dollars . Cents Dollars . Cents PREPARATION 1l 39,630 Mobilization At Lump Sum Haul %t7U[�D Per Lump Sum GRADING 3 39,630 Clearing and Grubbing At p Sum TL Haul %t7U[�D Per Lump Sum GRADING 3 39,630 Rotomilling Bituminous Pavement At S.Y. Haul 0 • '� 3S((o7 • -� Per Square Yard 4 3,952 Roadway Excavation Including At C.Y. Haul o at' 3/,4/r< . ��J Per Cubic Yard 5 2,284 Embankment Compaction At C.Y. —12" Diameter 6 • ' 13, ;V'/ Per Cubic Yard nRAINAGF 6 35 Plain Steel Culvert Pipe 0.064" Th. At L.F. —12" Diameter Per Linear Foot Road 3 -NE Reconstruction Project CRP 19.08 Proposal —Page 1 Item Plan Item Description Price per Unit* Totai Amount No. Quantity i Dollars . Cents , Dollars .Cents 7 240 Plain Steel Culvert Pipe 0.064" Th. At L.F. —18" Diameter %3• `= /7536. ; 96 Crushed Surfacing Top Course For At Per Linear Foot SURFACING 8 24,000 Crushed Surfacing Base Course At :y Ton Adjustment /6 $1.00 Per Ton 9 96 Crushed Surfacing Top Course For At Ton Approaches Per Ton HOT MIX ASPHALT 10 7,000 1 HMA CL. 1/2 IN. PG64-28 Paving At Ton Asphalt >7 . l03 Per Ton 11 Calculated Job Mix Compliance Price At :y 1 Adjustment -1.00 $1.00 Calculated 12 Calculated Compaction Price Adjustment At 1 -1.00 -$1.00 Calculated TRAFFIC 13 29,385 Paint lineAt At :y L. f. 1 O.?1 g�27•go Per Linear Foot 71�1 Centerline Rumble Strip At �!�/� . =" y,� • � IPerMile 15 4.0 Shoulder Rumble Strip Type 3 At Mile /QA2 72 SO , Per Mile 16 1 Project Temporary Traffic Control At :y Lump Sum /////////•///// Per Lump Sum Road 3 -NE Reconstruction Project CRP 19-08 T Proposal —Page 2 Item Plan Item Description I Price per Unit* Total Amount { No. Quantity Dollars. Cents Dollars. Cents { OTHER ITEMS 17 1 SPCC Plan At Lump Sum Per Lump Sum 18 4 Monument At Each /9410 , b 74,: Each 19 1 Trimming and Cleanup At Lump Sum lllllllll•/llll SurxJ . a + Per Lump Sum 20 4 Acre Seeding, Fertilizing and Mulching, With Roadside Mix At `—' �7Qe7� , j136 , Acre 21 $1.00 Minor Change At Est. $1.00 Est. Project Total 1,/.29 972 -,go Road 3 -NE Reconstruction Project CRP 19-08 Proposal —Page 3 - --v Failure to return this Declaration as part of the bid proposal package will make the bid nonresponsive and ineligible for award. NON -COLLUSION DECLARATION I, by signing the proposal, hereby declare, under penalty of perjury under the laws of the United States that the following statements are true and correct: 1. That the undersigned person(s), firm, association, or corporation has (have) not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with the project for which this proposal is submitted. 2. That by signing the signature page of this proposal, I am deemed to have signed and have agreed to the provisions of this declaration. NOTICE TO ALL BIDDERS To report bid rigging activities call: 1-800-424-9071 The U.S. Department of Transportation (USDOT) operates the above toll-free "hotline" Monday through Friday, 8:00 a.m. to 5:00 p.m., Eastern Time. Anyone with knowledge of possible bid rigging, bidder collusion, or other fraudulent activities should use the "hotline" to report such activities. The "hotline" is part of USDOT's continuing effort to identify and investigate highway construction contract fraud and abuse and is operated under the direction of the USDOT Inspector General. All information will be treated confidentially and caller anonymity will be respected. Revised 6/14 From OOT Form 272-0361 EF 07/2011 Road 3 -NE Reconstruction Project CRP 19-08 Proposal —Page 4 Certification of Compliance with Wage Payment Statutes The bidder hereby certifies that, within the three-year period immediately preceding the bid solicitation date (7/21/2020), the bidder is not a "willful" violator, as defined in RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding citation and notice of assessment issued by the Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. It,) h,, & )e,� /- z a, Mild, LL C Bidder's Business Name l� gnatur hor d Official` Printed Name Title Date City State Check One: Sole Proprietorship LJ Partnership Joint Venture Corporation C� State of Incorporation, or if not a corporation, State where business entity was formed: l'i /tiS/Ji/7 5' �r7n If a co -partnership, give firm name under which business is transacted: ' If a corporation, proposal must be executed in the corporate name by the president or vice-president (or any other corporate officer accompanied by evidence of authority to sign). If a co -partnership, proposal must be executed by a partner. ---- - — -- ---- - ----- - - - — Road 3 -NE Reconstruction Project CRP 19 -OS Proposal -Page 5 IF Proposal — Signature Page The bidder is hereby advised that by signature of this proposal he/she is deemed to have acknowledged all requirements and signed all certificates contained herein. A proposal guaranty in an amount of five percent (5%) of the total bid, based upon the approximate estimate of quantities at the above prices and in the form as indicated below, is attached hereto: Cash ❑ In the Amount of Cashier's Check ❑ Dollars Certified Check ❑ {$ j Payable to the Grant County Treasurer Proposal Bond Er' In the Amount of 5% of the Bid Receipt is hereby acknowledged of addendum(s) No.(s) _, _ & Signature of Authorized Official(s) Proposal Must Be Signed ` Z���, Please Print Name of Authorized official Firm Name J yL /i Q-,y,—Ag s LLL Address 2007 �- %r6d, & State of Washington Contractor's License No. Zn""Gt #E Z/ EJ— cEPAGU0 Federal ID No. yS 3Sy X6.20 Note: (1) This proposal form is not transferable and any alteration entered hereon without prior permission from the County Engineer will be cause for considering the proposal irregular and subsequent rejection of bid. (2) Please refer to section 1.02.6 of the standard specifications, re;"Preparation of Proposal" or "Article 4" of the Instructions to bidders for building construction jobs. (3) Should it be necessary to modify this proposal either in writing or by electronic means, please make reference to the following proposal number in your communication' Revised 8/95 Road 3 -NE Reconstruction Project CRP 1908 Proposal—Page 6 Bid Bond KNOW ALL MEN BY THESE PRESENTS: That we,as Principal, and North American Spada Insurance C m as Surety, are held and firmly bound unto Grant County, Washington, as Oblieee• in the full and penal sum of five (5) percent of the total amount of the bid proposal of said principal for the work hereinafter described, for the payment of which, well and truly to be made, we bind our heirs, executors, administrators, successors and assigns, and successors and assigns, firmly by these presents. The condition of this bond is such, that whereas the principal herein is herewith submitting his or its sealed proposal for the following Grant County Project, 3 -NE ROAD PHASE 2 RECONSTRUCTION PROJECT, CRP 19-08, located in Grant County, Washington, according to the terms of the proposal or bid made by the Principal therefor, and the Principal shall duly make and enter into a contract with the Obligee in accordance with the terms of said proposal or bid and award and shall give bond for the faithful performance thereof, with the Surety or Sureties approved by the Obligee; or if the principal shall, in case of failure so to do, pay and forfeit to the Obligee the penal amount of the deposit specified in the call for bids, then this obligation shall be null and void; otherwise it shall be and remain in full force and effect and the Surety shall forthwith pay and forfeit to the Obligee, as penalty and liquidated damages, the amount of this bond. SIGNED, SEALED AND DATED THIS I Ith DAY OF Auoust 2020 Prinopai Surety North,A Jnr rr�rnnam,_�� Attorney -in -Fact ne Reinkensmeyer, Attorney-in•Fad Road 3 -NE Reronstruction Project CRPP 19 --OB- ------ — Proposal–Page S SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the Stale of New Hampshire, and having its principal once in the City orOverland Park. Kansas, and Washington International Insurance Company, a corporation organized and existing under the laws of to State of New Hampshire and having its principal once in the City of Ovetiand Park, Kansas, each does hereby make, constitute and appoint: THOMAS P. I IENTSCHELL, BRADLEY A. ROBERTS, JULIE A. CRAKER. KAREN J. SMITH, and JOANNE REINKENSMEYER JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliv r, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or my be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority 0.11 exceed the amount of FIFTY MILLION (550,000,000.00) DOLLARS This Power of Attomey is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9° of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on What of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution army such Power of Avorney and to attach therein the seal of the Company; and itis FURTHER RESOLVED, that the signature of such omcers and the seal of the Company maybe affixed to any such Power orAttomey or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile sent shall be binding upon the Company when so a(hxed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." �waurWv� By f �� F Anes i.AMvv<FWt'4ehAluINWUYq[�Inm,m�JlnnraeCwinl �SFfd. P'. �. lar] 1 a5evl=rVin Rdlea e(!1ea\aelne apaan lrevv Cape, �j I Illmnwd 1'T \It,\eel A.Bb.i[ ef—iC ere lra�Iii �� f mrtCwieel a 4eM hYr hnkee[=rxal\ Alarkee fp[Yllr Irnen Cwpen IN WITNT. SS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized omcers this 19 day ar JANUARY , 2018. North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: Ou this 19 day of JANUARY , 201 before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Michail A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly swam, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. Ofralat SEM Ix lua+xr i IMN,r PdLc. Su¢daev. U lnMW" PIs Ar. Kenny, Nmnry P,Il.hic 1, leery Goldban . the duly elected Assistant Sceistam of North American Specialty Insurance Company and Washington international Insurance Company, do hereby certify that the above and foregoing is a true and correct copy ora Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is stili in full fence and emect. M WITNESS WHEREOF, i have set my hand and affixed the seals of the Companies this l Ith day of August , 20 20 . +erten a/aueaa, vke rtadex a auulm smeup =r weu,eame senl„aanl Inmm ra.iay a Vaal Alpn[..shsear hrnaiCnepe=r Grant County Public Works 124 Enterprise St. SE Local Agency Subcontractor List Ephrata, WA. 98823 Prepared in compliance with RCW 39.30.060 as amended To Be Submitted with the Bid Proposal Project Name: 3 -NE ROAD PHASE 2 RECONSTRUCTION PROJECT Failure to list subcontractors with whom the bidder, if awarded the contract, will directly subcontract for performance of the work of heating, ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and electrical as described in Chapter 19.28 RCW, or naming more than one subcontractor to perform the same work will result in your bid being non-responsive and therefore void. Subcontractor(s) with whom the bidder will directly subcontract that are proposed to perform the work of heating, ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and electrical as described in Chapter 19.28 RCW must be listed below. The work to be performed is to be listed below the subcontractor(s) name. To the extent the Project includes one or more cateeories of work referenced in RCW 39.30.060. and no subcontractor is listed below to perform such work, the bidder certifies that the work will either Ill be performed by the bidder itself. or (ii) be performed by a lower tier subcontractor who will not contract directly with the bidder. Subcontractor Name _ Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Bidder's are notified that the opinion of the enforcement agency PVC or metal conduit, junction boxes, etc, are considered electrical equipment and must be installed by a licensed electrical contractor, even if the installation is for future use and no wiring or electric current is connected during the project. A licensed electrical contractor must be listed to perform the work. Road 3 -NE Reconstruction Project CRP 19-08 Proposal— 7age 9 WHEELER EXCAVATION LLC. 2007 E. Highland Ext. Benton City, WA 99320 wheelerexcavadonllc.@yahoo.com Washington Contractor License: CCWHEELELS9000 Oregon Contractor License: 204620 August 10, 2020 Re: Grant County: 3 -NE Road Phase 2 Reconstruction Project To whom it may concern, Wheeler Excavation LLC. received quotes'Oom the following companies for the Grant County 3 -NE' Road Phase 2 Reconstruction Project: • Central Washington Asphalt • PSC -Pavement Surface Control • Ground Up Road Construction Inc. • King Hydroseeding Inc. • Columbia Basin Striping • North Star Enterprises Inc. • Apply -A -Line, I.I.C. • American Surveying & Environmental LLC. • Safe Set • H.D. Fowler • Granite Construction Co. • Northwest Asphalt • Cates & Erb Inc. • CegnarCo. • Core & Main • Arrow Construction Supply • Washington Green Hydroseeding • SSEC Apex T ALPX- ygt{ it elley Wheeler Wheeler Excavation Wheelerkelley207 iDvahoo.com 509-497-1235 Chad Wheeler From: Mat McDaniel <matgmcdanielftmail.com> Sent: Wednesday, August 12, 2020 6A3 AM To: wheelerexcavation Subject: Grant Co. Wheeler Excavation contacted NW Striping & Sealing/Asphalt regarding the Grant County 3 NE Road Reconstruction Project, but unfortunately we were unable to provide said company with a number. DBE Certification Number: DlMO026259 Mat McDaniel NW Asphalt 509-895-4659 Project Details ALC LE i LL ..LLBY --m hmLF.mlagta I mr-fnlacis I rmyjkmA" I Statlatical R ... —h I Laws 6 Awards I ALChive If, View D—enls Ynlh pa®pFp m.va.m ..nwe.. Fnmogamm nw.+nbNmbm, nN,pp.n p..x llv �. Unitlu. n.lran:s iad w+ ❑TrrNNYro.u.F OTre.NrJo.r..0 I]Xid. in Pian `••�Atldamm4.0am WOWwY 3 -NE Road Phase 2 Reconstruction Project - Grant County Prot l0: 1p]DncrE oxun RN.ID. caP to-oe Y INFI]gY4 dl _ Bb we: Ntt/2010 BY InbmWm: altl TNr: t b all P[ amo NwrNr Flet R.pon Dob: ]/t-20 LaM UplPbd: 6'IV2@0 Nob.: TN pbn Rbwr li.l lx tAb PnN6 m.Y M cmnxlxd of wmp.nlx iV.l a.x'W %rpnblaC m V.o b.ulnp Ap.nry xM.ILL abn..m. Ap.xb. Fn rrol n.vn ngl.VNlen M.n ooAmlutllnp • pro7.ct. m.Ib+x01 b.IrampbLL AOtlYmNll%.Om.I.aWnp Ap.nclx nelanp.r mNNNn wYu prorM. c pbn M1Na..11.L InMfxNtl tamp.W. my+Nl In.mxlr.. to ib. %.n Gnbr Nldri px aNbN ame or cenlM N. M.n GnW for mon lnlatvXen N Wort oounry moOP Gu+ICanN. WA" utoLax loatlwalxanlnn..rrowmnell WnpMbn c�rtNl.WaDra Cue mune.pwn.tl wrlaorp mP ]Na.gN.D Pontl..MM.+xanvuc4onm2a mb.al".lyn. tmpw -- PRW ER L—. PRDlECT CAM Pr.I..t T]x;I--- -.,P—ton Cabpory:C—,v -.,P— Grmu Cu. WA Etna Btld.n Lbl UpONs blit: Yn CeumY: GnN (wn) _ VJN W e� C.nr.tlon LLC P,- Motn: —SWDEYDNTEAN: Owner I=17-= Donee. Nem BN.x bg�0 l`+Dal r5.E08] FAY10 EpI.W. WA 8!R] MAM81NFgeWTON E.Vm.bd C..1 en.blwn: Plmv.lm LaaVm: ONIn oN] ObY M—F—: DNxoIC Ntl R.IUMatl. Np ADbrW Amxlmeb aM.mx Nro bxnr.ODlatl TOfµ EblIYATED .—.—A— BDOERl MBT Q len lM ovl.^. CmnPNWpIn nO.ro mmrMn MmY aillt. MxM Asphalt Contractor ® is50Boai s� `may �a-�Ws c.. rleRnd.rnn I31a1 E'W.We Roel .D B.a 0a9 Mmx Uta. WA NY02 Excavation Coniracla (tDFi rO)9rzt ConYCV . W laYxla. M. P'DE 1378 (�I ra2�9]D iAl Bella Ma.x V V. WA X8N] Supp ..rGrR.mY a js 151yp ]B FAX Robel Flim ]100 E FmrOr Luq P..e.01 GLL 116 ,,,OjtPORALLYW11IfSAW 6.••.r t EOYIPIN.TlTNamY CDYPFIITDIEPWONri DN RENTALS, BaRVICF. AND PARTM Traffic Controlf5triping TnNC N.n.gF{yplJpa ('0p181D 10Dt Cahn: FAX 58nder% tISM1 tA� (8W1aXD30OJ HVRIt RNNW, WA 98DSl CONrROI.:PAVEYENTYARI�IOaIPRDYOEAND METALL INTENDII AND 6XtER10R8pNADE WAYFlNdMO AND d1ECtalEEIrEC01110N YD WOE DIIYIL810NLL SIOIIADE POET AND PANEL ""EMT ANDPA General Contractor _ � (ilo�Ya �[ nmlMranM BvnnA BMMtt ipin.lricityplan rteccoMpiri/Pro,,niDetail.asp'WPlD=2020-OC7E Protect Deta9s ® fe u�Nt� 13031tl19-t2@ fAx Camara ENmv E.tlnYnn - Chan Ylnenl9r eanbn CRj. WA 38)ZO Et9cOUY3GE BCS FROY Au IYBE. YB[.OBE 9UBCOYrNAC10B! aYB tM lllflUElU 15W11SFTl9Z WnYa: 11�I 1�999�IA Ngbwv[t X41 908113aO1C Mx �u II19 EOniYa. WA 9980 ISWI-039t fAi ewYee tnv N Ull�n Epw,. wA eeea VIM EpW MW Wnt n90 E3NaY WA 39921 Tri -City Construction Council (509) 592-7424 - Fax(509)582-6815 20 East Kennewick Avenue - Kennewick, WA 99336 ipin.tncilyplancerteccomrtp;n/ProjectCetail.asp?WPIC=2020-OC7E 2,12 811212020 Pro]eq Detais II l,adrns.:V Auaal 11 202J (I plancenter.net-- �1�1 $SFTiw�.'J T:; r':J I.+'JL -""" -"-"` ADDENDA PLANE SPECS 127—It with small CT—k wife small CMce In Filters Unlqud Visitors:— Total Vlsits:� Grant Court • 3 -NE Road Phase 2 Reconstruction Project Pro]. ID! 20203525 D—m Rei. ID: CRP 1&08 BID INFORMATION Bid D w ittl IM020 BW Infonnetic, Bid Time: 110p. PT BWs Security: 5% of the amount of such Nd proposal First Report Date: 7/2112020 Nobs: scop. e1 Wgrk: 1 This caltract pmvdes!or the remnslruNm e12.0 miles of mo lana county mad In Grant County. WA and Inck:des roadway excavation, embankment mmpacLon. =09dW base mune. prusnad suds t murw MMA, seed and leasL.W. and other work PROJECT LOCATION PROJECTSTATUS FMJnct Type: Noy-Buidmg Phase: Apparent Lows Cabgory: Road Work Ephrata, WA 98823 Last Updated: 611612020 Public: Yes County: Grant WA _ -- Wheeler Excavation LLC Project Nates: ® OWNEWIDESIGN TEAM: Owner Grant County Puhllc Worka ® (509)751.6062 COMIct: Designations: 124 Enterprise St SE (500) 751.6087 vex No contact listed Ephrata, WA 96823 PLANS INFORMATION Entreated Cost Breakdown: Planraom Location: ONirta only Doeunent information: Online (Spas and Plans) Deponit: Not Re6mdable No Addenda. Amendments or Memos have been reported OTAL ESTIMATED COST: None Available BIDDERS LIST: Click hen for mom bidders list eetlene Companies In red arc members of this onkne network Aaphait Canlractor Gnnke Conetructian C. allay (509)248.8376 Contact: Designations: 80 Porto Rd (509) 578.7058 Fax No mnmcl listed Yakima. WA 96901 Cental W>_shingt2n Alighck lac (509)765.5757 Contact: Designations: PO Sox 939 (509) 765.8052 raz Cnna"y F.Taa Modes Lake, WA 88837 General Contract« HLTConm,r-tlnn M (SH) 928-4200 Conlaeb Designations: 4207 N Four Rd (509) 9264083 rax No conrecl listed Spokane. WA 99206 --`_-- Whaler Eawation LLC 0 F&C-hidtnln (509)497.1235 Contin: Designations: I 2007 E Highland Extension (509) 487-1202 rax Cnad VA W r Semen City, WA 99320 Encourage Bids (fent all MBE. WBE, DBE suppliers and vendors Tommer Constrution Co Inc (509)764.3302 Contact: Deaipnatlons: Po Box 1150 (509) 754-3642 rax LgmpacY —ri Ephraw. WA 98823 Sitevrork Commder M (508)762-8421 Contact: Designations: ipin.plarlcenter. neD)PIhUPmjec[Detail. asp?tWt?ID=2020-3525 A`COR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/31/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Danielle Bryant NAME: HENTSCHELL & ASSOC INC ANON o Ext): (253) 272-1151 AX No): (253) 272-1225 1436 S. Union Ave. ADDRESS: danielleb@hentschell.com INSURER(S) AFFORDING COVERAGE NAIC # Tacoma WA 98405-1925 INSURERA: Ohio Security Insurance Co. 24082 INSURED INSURER B: Ohio Casualty Insurance CO. 24074 INSURER C : Wheeler Excavation, LLC. INSURER D: 2007 E. Highland Ext INSURER E: INSURER F Benton City WA 99320 COVERAGES CERTIFICATE NUMBER: 20121 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1 - -i OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL SADV INJURY S 1,000,000 A Y Y BKS61371664 05/14/2020 05114/2021 GEN'LAGGREGATE LIMITAPPLIES PER I GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY � JET � LOC I Wa StopGap/Empl Liab S 1,000,000 OTHER AUTOMOBILE LIABILITY COM BINEDSINGLE LIMIT $ 1,000,000 Ea accident) BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) s A OWNED XSCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY AUTOS ONLY Y Y BAS61371664 0511412020 05/14/2021 PROPERTY DAMAGE $ Per accident S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 B EXCESS LIAB CLAIMS -MADE Y Y US061371664 05/14/2020 05/14/2021 DED I X RETENTION S 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA TT WASHINGTON STATE FUND X STATUTE EERPER H E . EACH ACCIDENT S E L DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ If yes, descnbe under DESCRIPTION OF OPERATIONS below Inland Marine BKS61371654 05/14/2020 05!14!2021 Leased/Rented 300,000 LIMIT ' Equipment DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule; may be attached if more space is required) Project: TA -6933 / 3- NE Road Reconstruction Project Phase 2 - STPR-P130 (006) Blanket primary non-contributory additional insured including additional insured including completed operations additional insured, Blanket Waiver of subrogation applies in favor any person or organization as per written contract per policy forms CG8810 04113, CG8870 12/08, CG8583 04113, AC8501 06/18, Umbrella Policy is Following Form - Grant County PUD, and its officers, elected officials, employees, agents and volunteers are included as additional insureds i VMI\VGLLJ\I IVI\ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Grant County PUD ACCORDANCE WITH THE POLICY PROVISIONS. P O. Box 37 AUTHORIZED REPRESENTATIVE Ephrata WA 98823 V 1970--!U10 ALUKU LUKVUKAI fun. Ali rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 88 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON -OWNED AIRCRAFT 2 NON -OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY—ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS — COVERAGES A AND B 3 ADDITIONAL INSUREDS — BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY — ADDITIONAL INSURED EXTENSION S ADDITIONAL INSUREDS —EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED — INCIDENTAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN INSURED — 6 FELLOW EMPLOYEE EXTENSION — MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US — 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU r 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted rnatehal of Insurance Services Office, Inc- with its permission. Page 1 of 8 With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON -OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section i — Coverage A - Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured: 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON -OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long: and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY — ELEVATORS 1. Under Paragraph 2. Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability, Subparagraphs (3), (4) and (6) of exclusion J. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV — Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 8 The last paragraph of subsection 2. Exclusions is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section 111— Limits Of Insurance. Paragraph 6. under Section III — Limits Of Insurance is replaced by the following: Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection systems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenants Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract". E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I —Coverage C — Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS — COVERAGES A AND B 1. Under Supplementary Payments — Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II — Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in partby: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury' or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or 0 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8 Premises or facilities rented by you or used by you; or The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions. (1) This insurance does not apply to "bodily injury", "property damage"., or "personal and advertising injury' arising out of the operations performed for the state or political subdivision: (2) This insurance does not apply to "bodily injury' or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent.. or control but only with respect to the following hazards: The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph t.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage", We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Dutles In the Event Of Occurrence, Odense, Claim Or Suit under Section IV — Commercial General Liability Conditions. 0 2013 Liberty Mutual Insurance CG 88 10 04 13 Incudes copyrighted material o1 Insurance Services Office, ina, vAth ds permission. Page 4 of 8 With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured. b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury° or 'properly damage' occurs. C. "Bodily injury", "property damage' or "personal and advertising injury' arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury', involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "Bodily injury' or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION iv - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. ® 2013 Liberty Mutual Insurance CG 88 10 U4 13 Includes copyrighted material of Insurance Services Office, Inc., vdth its permission. Page 5 of 8 b, The following is added to Paragraph b, Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit' under this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and C. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section III — Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS ! MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section 11 - Who Is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injurer': (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co -"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional hearth care services. However, if you are not in the business of providing professional health care services or providing professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. 0 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 8 Paragraphs (a) and (b) above do not apply to "bodily injury' or "personal and advertising injury caused by an 'employee' who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the .employee's'job responsibilities assigned by you, includes the direct supervision of other 'employees" of yours. However, none of these "employees" are Insureds for'bodily injury" or 'personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause'bodily injury or'personal and advertising injury, or caused in whole or in part by their intoxication by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee'. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3, of Section II - Who Is An Insured is replaced by the following: Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and C. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV — Commercial General Liability Conditions, the following is added to Condition 6. Representations: Your failure to disclose all hazards or pdor'occurrences' existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV — Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence', offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured fisted under Paragraph 1. of Section tl — Who Is An insured or a person who has been designated by them to receive reports of 'occurrences', offenses, claims or "suits" shall have received such notice from the agent, servant or 'employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability —Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. O. BODILY INJURY REDEFINED Under Section V — Definitions, Definition 3. is replaced by the following: "Bodily Injury means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sickness or disease. 0204.3 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.. with Its permission. Page 7 of 8 EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US — WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV — Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 COMMERCIAL GENERAL LIABILITY CG 88 70 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S) - GENERAL AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical ex- penses caused by accidents under Section I - Coverage C Medical Payments, which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Cov- erage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project, Such payments shall not reduce the General Aggregate Limit shown In the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However., instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical ex- penses caused by accidents under Section I - Coverage C Medical Payments, which cannot be attrib- uted only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C, When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the projectwill still be deemed to be the same construction project. E. The provisions of Section III . Limits Of insurance not otherwise modified by this endorsement shall continue to apply. CG 88 7012 08 includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 85 83 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED CONTRACTORS - PRODUCTS/COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. under SWIon li - Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional Insured in a written contract or written agreement. Such person or organization Is an additional insured but only with respect to liability for "bodily injury" or "property damage": I. Caused by "your work" performed for that additional insured that is the subject of the written contractor written agreement; and 2. Included in the "products•cempleted operations hazard". However: a) The insurance afforded to such additional insured only applies to the extent permitted by law; and b) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Conditions. B. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I • Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: 1. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs. 2. "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawing and specifications; and b. Supervisory, inspection, architectural or engineering activities. ® 2013 Liberty Mutual Insurance CG 85 83 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 2 C. With respect to the insurance afforded by this endorsement, exclusion 1. Damage To Your Work of Paragraph 2. Exclusions under Section I - Coverage A- Bodily Injury And Property Damage Liability is replaced by the following; 1. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard". D. With respect to the insurance afforded to these additional Insureds, the following is added to Section 11 - Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance; 1. Required by contractor agreement; or 2. Available under the applicable Limits of Insurance shown In the Declaration. whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. E. With respect to the insurance afforded by this endorsement, Section IV - Commercial General Liability Conditions is amended as follows; 1. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claims Or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; , b. Tender the defense and indemnity of any claim or "suit" to all Insurers whom also have insurance available to the additional insured; and c. Agree to make available any other Insurance which the additional insured has for a loss we cover under this Coverage Part. & We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured, 2. Paragraph 4. of Section IV -Commercial General Liability Conditions is amended as follows: a. The following Is added to Paragraph a. Primary Insurance: . If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional -insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. b. The following is added to Paragraph b. Excess Insurance* When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insur- ance is excess over any other Insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies, 0 2013 Liberty Mutual Insurance CG 85 83 04 13 Includes copyrighted material of insurance Services Office, Inc., with its permission Page 2 of 2 COMMERCIAL AUTO AC 85010518 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. . If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGE INDEX SUBJECT PROVISION NUMBER ACCIDENTAL AIRBAG DEPLOYMENT 13 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 4 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 21 AMENDED FELLOW EMPLOYEE EXCLUSION 6 AUDIO,VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 15 BODILY INJURY REDEFINED 26 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 3 EXTRA EXPENSE - BROADENED COVERAGE 11 GLASS REPAIR - WAIVER OF DEDUCTIBLE 17 HIRED AUTO COVERAGE TERRITORY 23 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 7 LOAN / LEASE GAP (Coverage Not Available In New York) 16 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 2 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 18 PERSONAL EFFECTS COVERAGE, 12 PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 9 PHYSICAL DAMAGE DEDUCTIBLE - VEHICLE TRACKING SYSTEM 14 PRIMARY AND NON-CONTRIBUTORY - WRITTEN CONTRACT OR WRITTEN AGREEMENT 24 RENTAL REIMBURSEMENT 10 SUPPLEMENTARY PAYMENTS 5 TOWING AND LABOR 8 TRAILERS - INCREASED LOAD CAPACITY 1 TWO OR MORE DEDUCTIBLES 19 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 20 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 22 SECTION I • COVERED AUTOS is amended as follows: 1. TRAILERS- INCREASED LOAD CAPACITY The following replaces Paragraph C.I. Certain Traitmrs, Mobile Equipment Ansi Temporary Substitute Autos of SECTION I - COVERED AUTOS: "Trailers" With a load capacity of 3,000 pounds or less designed primarily for travel on public roads. ® 2017 Liberty Mutual Insurance AC 86 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 1 of 7 SECTION 11- LIABILITY COVERAGE is amended as follows: 2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION 11 - LIABILITY COVERAGE, Paragraph A.I. - Who Is An Insured is amended to include the following as an "Insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. However, "Insured" does not Include any organization that: (1) Is partnership or joint venture; or (2) Is an "Insured" under any other automobile policy except a policy written specifically to apply In excess of this policy; or (3) Has exhausted its Limit of Insurance or had Its policy terminated under any other automobile policy. Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 3. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to Include the following as an "Insured": a. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other Insurance available to any "employee". f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION If - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to Include the foliowing as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed In a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization Is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been Issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and Indemnity. Unless the "insured" has agreed In writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance. S. SUPPLEMENTARY PAYMENTS SECTION 11 - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. ® 2017 Liberty Mutual lnsurance AC 86 0100 18 Includes copyrighted material of insurance Services Office Inc., whh its Permission. Page 2 of 7 6. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: SECTION II - LIABILITY, Exclusion B.S. Fellow Employee does not apply if the "bodily Injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage Is excess over any other collectible insurance. SECTION III -PHYSICAL DAMAGE COVERAGE Is amended as follows: 7. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION lit - PHYSICAL DAMAGE COVERAGE, Is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor Incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that Is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss". B. TOWINGANDLABOR SECTION III - PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the. limits shown below, each time a covered "auto" classified and rated as a private passenger type, "Iighttruck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. 0 2017 Liberty Mutual Insurance AC 85 01 0618 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 3 of 7 9. PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPME COVERAGE Paragraph AA.a. Coverage Extensions, Transportation Expenses of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500, 10. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, Is amended by adding the following: 9. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex- penses incurred afterthe first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lessor vehicle, which in many cases may be substantially less than $76 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. a. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Externion. f. No deductible applies to this coverage. S. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is In addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 12.8. 11. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000 12. PERSONAL EFFECTS COVERAGE A. SECTION III -PHYSICAL DAMAGE COVERAGE, A. Coverage, Is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible Insurance. B. SECTION V - DEFINITIONS is amended by adding the following: For the purposes of this provision, '*personal effects" mean tangible property that is worn or carried by an "Insured," "Personal effects" does not include tools, equipment, jewelry, money or securi- ties. 13. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess ov.er mony, c-thei collectible [;,strap or rohm.bursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 0 2017 Liberty k4utual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 4 of 7 14. PHYSICAL DAMAGE DEDUCTIBLE - VEHICLE TRACKING SYSTEM SECTION iII - PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown In the Declarations will be reduced bye for any "foss" caused by theft if the vehicle Is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 15. AUDIO, ViSUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu- sions 4.c. and 4.d. Is deleted and replaced with the following: Exclusions 4.c. and 4.d. do not apply to: a. Electronlc equipment that receives or transmits audio, visual or data signals,- whether or not de- signed solely for the reproduction of sound, if the equipment is: (1) Permanently Installed In, the covered "auto" at the time of the "loss" or removable from a housing unitthat is permanently installed in.thecovered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 16. LOAN I LEASE GAP COVERAGE (Not Applicable In New York) A. Paragraph C. Limit Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you In any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss"; b. Financial penalties Imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur- ance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a "Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto"; g. Security deposits not refunded by a lessor; h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto"; I. Any amount representing taxes; j. Loan or lease termination fees; or 2, The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss" ® 2417 Liberty Mutual Insurance AC 85 01 06 18 Inciudes copyrighted m®terial of Insurance Services office Inc., with its Permission. Page 5 of 7 C. SECTION V- DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" In which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are Insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. 17. GLASS REPAIR - WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 18. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" If the covered "auto" is in the charge of any person or organization engaged in the automobile business. 19. TWO OR MORE DEDUCTIBLES Under SECTION Ili - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, It will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph 8.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep- tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. ® 2017 Liberty Mutual Insurance AC 85 0106 18 includes copyrighted material of Insurance Services office Inc, with its Permission. Page 6 of 7 21. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUiT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.2.e. Is replaced in its entirety by the follow- ing: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you area partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation, To the extent possible, notice to us should include: (a) How, when and where the "accident" or "loss" took place; (b) The "insureds" name and address; and (c) The names and addresses of any injured persons and witnesses. 22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 23. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph 8.7. Policy Period, Coverage Territory, is amended by the addition of the following: f. For `:autos" hired 30 days or less, the coverage territory is anywhere In the world, provided that the "insured's" responsibility to pay for damagesIs determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or In a settlement we.agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. 24. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN, CONTRACT OR WRITTEN AGREE- MENT The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, General Conditions, B.S. Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other irisurance available to an "Insured" under your policy provided that:. 1. Such "insured" is a Named insured under such other insurance; and 2. You have agreed.in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". SECTION V - DEFINITIONS is amended as follows: 25. BODILY INJURY REDEFINED Under SECTION V - DEFINITIONS, Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. 0 2017 Libery Mutual Insurance AC 85 0106 18 Includes copyrighted material of Insurance Services Office Ino., with Its Permission. Page 7 of I W 11*%rCM Department of Labor & Industries Certificate ofWorkers' Compensation Coverage WA UBI No. L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? License No. License Expiration June 1, 2020 603 143 395 995,-,79-01 WHEELER EXCAVATION LLC WHEELER EXCAVATION LLC Account is current. Quarter 1 of Year 2020 "0" Workers mployer Services Help Line, (3M 902-4817 Yes 'WHEELEL890OO 09/20/2021 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 8/12/,)0?0 Project Details ipin.plancenter.neUIPIN/ProjeciDetail.asp?txtPID=2020-3525 212 AML Washington State Underutilized Disadvantaged Business Enterprise UDBE Written MYDepartmentof TMarlsportation /� Confirmation Document See Contract Provisions: UDBE Document Submincl Regairen3ents Disadvantaged Business 1"nternndse Participation THIS FORM SHALL ONLY BE SUBMITTED TO r, UDBE THAT IS LISTED ON THE CONTRACTOR'S UNDERUTILIZED DISADVANTAGED BUSINESS ENTERPRISE UTILIZATION CERTIFICATION. THE CONTRACTOR SHALL COMPLETE PART A PP [OR TO SENDING TO THE UDBE. PART A: To be completed by the bidder The entries below shall be consistent with what is shown on the Bidder's Underutilized Disadvantaged Business Enterprise Utilization Certification. Failure to do so will result in Bid rejection. Contract Title: 3 —/I/l %Zda.) JP&s, eJ Bidder's Business Name: LL L UDBE's Business Name: Description of UDBE's Work: 7,,- 4'� 4 Dollar Amount to be Applied Towards UDBE Goal: �l9 Dollar Amount to be Subcontracted to UDBE': 'Opt(onel Reid PART B• To be completed by the Underutilized Disadvantaged Business Enterprise As an authorized representative of the Underutilized Disadvantaged Business Enterprise, I confirm that we have been contacted by the Bidder with regard to the referenced project for the purpose of performing the Work described above. If the Bidder is awarded the Contract, we will enter into an agreement with the Bidder to participate in the project consistent with the informationprovidedin Part A of this form. Name (printed): El) I X 1 � CI' �)Tr- Signature: (/j Signature: Title: Address: bn1n��, lir 9Ff4 nOTForm422-03/U RevlMd 0312018 Date: � 111 17-0 )-t) Cates & Erb,, Inc, PO Box 2027, Omak, WA 98841 August 11, 2020 Attn: Chad Wheeler Wheeler Excavation 2007 E. Highland Ext. Benton City, WA 99320 RE: Grant Co. 3 NE Rd. Reconstruction Project - Trucking Proposal Dear Mr. Wheeler: We are pleased to give you the following trucking proposal for the above-mentioned project. Please see below our rates. • Truck & Pup - $150.00 per hour • Belly Dump - $150.00 per hour • Per Diem - $125.00 per day/per employee NOTE: This proposal is for 3 trucks either truck & pup or belly dumps (whichever we have available at the time) for 14 days at 10 hours per day. Our time starts and finishes from our shop in Omak. If you have any questions or need anything else, please don't hesitate to contact us. Sincerely, Robert Erb, Jr., President Phone: 509-826-4752 / Fax: 509-826-2160 / Email: catesanderb0Snc1data.com / Website: catesanderb.com AMAPn`Underutilized Disadvantaged Business ° 'gig " ofTmi siportlitUon Enterprise (UDBE)Trucking Credit Form PART A: TO BE COMPLETED BY THE BIDDER This form Is in support of the trucking commitment Identified on the UDBE Utilization Certification Form submitted with the proposal. Please note that UDBE's must be certified prior W time of submittal. oral Aid # Contract # a CRP /I -O$ 1 !f listing i by hours, or by lump sum amounts, please provide cekulations to substantiate the Quinkes listed. s Address!(% HNQ X ja r O E i 1 certify that the above Informaton is complete and accurate. Use additional sheets as ar J � me?tle (pl sed pdntj�- Phone F Signature Address!(% HNQ X ja r O E i 1 certify that the above Informaton is complete and accurate. l ( Date c5 �� PART B: TO BE COMPLETED BY THE UDBE TRUCKING FIRM Note: DSEIUDBE trucddng firm participation may only be credited as DBEIUDBE participation for the value of the hauling services, not for the materials being hauled urge" the trucking firm is also recognized as a supplier of the materiels used on the project and approved for this project as a regular dealer. 1. Type of Material expected to be hauled? 'Irk "{ice Cfil r5G 2. Number of fully operatonal trucks expected to be used on this project? Trectorttrallers: Dump trucks: 3. Number of trucirs end tracers owned 7 by the UDBE that wcl be used on this Tractorltrallers; . -) Dump bucks: project? d. Number of trucks and tracers leased by the UDBE that Will be used on this Tractorltracerw Duro trucks:Project? P UDBE Imt Name C I NemelTitle (please print) \�I'LL, . _ Cenificentl`on Numrb�er Phone -SrLU �I�SZ Fax ca^� fiLlp 21 rn Signature Address (IY11 Glc LI;C� gd'&LI j Emac I certify that the above information is cum pias and accurate. PAVeSaMz—Ib6tic,LLt�gl cot)' Date DOT Form M -M Revlsed 052019 RtUt� Washi gton ' Depar men Mate Underutilized Disadvantaged Business Department of Transportation Enterprise Utilization Certification To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, an Underutilized Disadvantaged Business Enterprise (UDBE) Utilization Certification. The Contracting Agency shall consider as non-responsive and shall reject any Bid Proposal that does not contain a UDBE Utilization Certification which properly demonstrates that the Bidder will meet the UDBE participation requirements in one of the manners provided for in the proposed Contract. Refer to the instructions on Page 2 when filling out this form or the Bid may be rejected. An example form has been provided on Page 3. The successful Bidder's UDBE Utilization Certification shall be deemed a part of the resulting Contract. Box t: 1AA.!Jrr bK-L, j I'O. r L[ C- certifies that the UDBE firms listed below have been contacted regarding participation on this project. it this Blader Is successful on this project and is awarded the Contract, it shall assure that subcontracts or supply agreements are executed with named UDBEs. (If necessary, use additional sheets.) Box 2: 3 AlA/'E / o/ ��Jz Z /?ace�s}� c�yen P-)rz Column 1 Column 2 Column 3 Name of UDBE Project Role Description of Work (See instructions) (See instructions) (See instructions) Column 4 DollarAmount Subcontracted to UDBE (Sae,nstructlons) Cdumn 5 Dollar Amount to be Applied Towards Goal (Sea instructions) Underutilized Disadvantaged Business (07, 06V -__Total UDBE Commitment Dollar Amount b01 zsri "- Enterprise Condition of Award Contract Goal Bos 3 Box a 5 MBy checking Box 5 the Bidder is stating that their attempts to solicit sufficient UDBE participation to meet the OA Contract goal has been unsuccessful and good faith effort will be submitted in accordance with Section 1-02.9 of the Contract DOT Form 272-066U Revised 0312016 Aft Washington State Underutilized Disadvantaged Business WI/ Department of Transportation Enterprise (UDBE) Bid Item Breakdown Form 1. Contract Number 2. Contract Name IVF— Aj 12e, 3. Prime Cgqntractor 4. Prim IC/ontractor Repres ntative Name 5. Prime Contractor Representative Phone Number 6, Prim) Contractor Represent tive Email fvS-y�7-/235— Wijt cdumn 1 Na" of UDBE (seernaaXIb-) Cok�mn 2 Bid ttem 0 (S"hwoc"%) C.*xr,6 3 FulliPartial (seaW*A4+arf) C06= a Quattttgl (seelris-Czm) column 5 Description ft (i ,,) Cok mct 6 Unit Price (S"I aa) Cdu� 7 Total link Cost (See lns tructlorrc) Cok,mn e Dollar Amount to be Applied Towards Goal (s.e rn,m,�iQr1 ,!3 S ,���� a F�,4 i "/,w 4�;, i,� �X, �-� /s'd�.l� G3, a, ` J 1�3, °Cv. 3-;1,5/-,4�S. �57J. 7-, -2 5.V, Subtotal: 0.00 0.00 Marne of UDBE Na Bid Rom 11 Full!Partlal Qua tatty Oascrlptlon tlnk Price Total UnitDollarArr Cost aunt to be Applied Towards Goal Subtotal: $ 0.00 $ 0.00 Name of UDBE Sid item 0 FuliMartlal Quanttty Description Unit Price Total Unit Cost Dollar Amount to be Applied Towards Goal Subtotal: $ 0.00 $ 0.00 Nam" of UDW Bid Kern X FulllPartlal QuantityDescription ptiort Unit Price Total Unk Cost nt to be Ap oiid to be Appli"d Towards Goal i i II Subtotal: $ 0.00 $ 0.00 TOTAL UDBE _Doll; 'Aitlount 5 0 do S 0,00 Cotl,2s�," pis, zs v. - DOT Form 272-054 Revised 0112020 c__��fa^�a�•os.-rcar_-i�r.--r^-^sa^�[^�c�r--�r'-7Q^nr-��cr:^sir-,.,-�,�--of^ir•-^---s^��—�a�-^'��'�*�o _�.:._. ¢•-._".c_'.'°� Washington state C, Disadvantaged Business Department of Transportation 9 Enterprise Utilization Certification To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, a Disadvantaged Business Enterprise (DBE) Utilization Certification. The Contracting Agency shall consider as non- responsive and shall reject any Bid Proposal that does not contain a DBE Utilization Certification which properly demonstrates that the Bidder will meet the DBE participation requirements in one of the manners provided for in the proposed Contract. Refer to the Instructions on Page 2 when filling out this form or the Bid may be rejected. An example form has been provided on Page 3. The successful Bidder's DBE Utilization Certification shall be deemed a part of the resulting Contract. Box 1: t,� Ccv4-J�`0— Z LCcertifies that the DBE firms listed below have been contacted regarding participation on this project. If this Bidder is successful on this project and is awarded the Contract, it shall assure that subcontracts or supply agreements are executed with named BEs. (If necessary, use additional sheets.) Box 2: 3 /✓!; / � 234—se- 2 %Zrco.,s/� P"i cl)' Column 1 Name of DBE (See instructions) Column 2 Column 3 Project Role Description of Work (See instru tions) (See InsImcdons) Column 4 Dollar Amount Subcontracted to DBE (See instructions) Column 5 Dollar Amount to be Applied Towards Goal (See instructions) 33&1, 31011 Disadvantaged Business Enterprise G 7 8tO , ` Total DBE Commitment Dollar Amount Condition of Award Contract Goal Bos 3 Boz 4 5 ❑ By checking Box 5 the Bidder is stating that their attempts to solicit sufficient DBE participation to meet the COA Contract goal has been unsuccessful and good faith effort will be submitted in accordance with Section 1-02.9 of the Contract DOT Form 272-056 Revised 032018