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Home My WebLink AboutContract Award - Public WorksCONTRACT THIS AGREEMENT, between the Board of -County Commissione.irs of. Grant COunty, State of Washington, actIngunderand byvirtueof aha pter36.7*7-of the.Aiev�sed Code ofwa, .1 sHngtot asznlended. herei after called the Co-unly and Central Wash nqti n in �:snxf' I or its ts heirs executors, aarnintstrators successorsand - ssll gns, herein -after called the Co ntract WITN ESSEX , ie That in cansi.deration of the pay ments, cov, nants and agreernents hereinafter menti d. aniaft-achedan• d mad e a part.of this, agreement,, to be made, and per `o *med by the f r pa,rties erem-and the paffies hereto Covenant and agree a.: ws DESCRIPTION OF WORK: di too I S.: 24 The Contractor shat provid,e and be at ... the, expe.nse ofall maitertcar bft. labor ago A el . I 't o: imp e ents can .conveniences and tnin, s -of every descrI f i * tion th:at may be re P quis' f the transfer of materials and f ucflng and comp'leting the work � p rovided'fo or.con.str . .1 is C011tract and even -partt.hereof% o r i. : ...... heirs -cutors 4. The Con. tract r fog h* m -self and for h's hei exe administrator W s. an;,� assigns, and successors and assigns, does hereby a to- the full performanc venants herein ..gree e of all the co conta:ined* upon ane Part of the Contractor. It R.further provided that,no llab.ifl'ty s. I ha.11 attach to. the County by reason of entering 'Into 1h'Istontract', except asexpressly provided here4n. �oad�5-U�;Rt U�-UW�0�verWy Contract — �j IN WITNESS WHEREOF, the said Contractor has executed this instrument, and the said Board of County Commissioners of Grant County has caused this instrument to be executed by and in the name of said Board by its Members, duty attested by its Clerk, the day and year below written, and the seal of said Board to be hereunto affixed on said date. ()'�j_day of 1 2019 7 J. Deputy Pro, , c to Attorney Signature Fenn Maiers, ... President Pnnt Name Central Washington Asphalt, Inc. Firm Name. P.O. Box 939 Address Moses Lake WA 98837 City state Zip (509) 765-5757 Phone BOARD OF COUNTY COMMISSIONERS OF GRANT COUNTYWASHINGTON Done this "day of 41q , � H.' - A Chair Member }� C,. Member Road 5-N WL & U -NW Overlay Project., CRP 18-01 --------- --- ------------------ I -- ..... . . Contract — Page 2--� CONTRACT BOND #023209688 KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, Central Washington Asphalt, Inc. as principal, and Liberty Mutual Insurance Company a corporation organized and existing underthe laws of the State of Massachusetts as surety corporation, and qualified under the laws of the State of Washington to become surety upon bonds of contractors with municipal corporations, as surety, are jointly and severally held and firmly bound to Grant Coun ty, Washington, in the penal sum of Two Million One Hundred Eighteen Thousand and No/1 00ths Dollars-------------------- $ 2,118,000.00 for the payment of which sum on demand we bindourselves and our successors, heirs, administrators or personal representatives, as the case may be. This obligation is entered into in pursuance of the statutes of the State of Washington, the Ordinances of Grant County, Washington. Dated at Seattle , Washington, this 20th day of August 2019. The conditions of the above obligation are such that: WHEREAS, on August 6, 2019, the Board of County Commissioners of said Grant County has let or is about to let to the Principal, a certain contract, the said contract providing for the improvement of Road 5 -NW & U -NW Overlay Project.,, CRP 19-02, located in Grant County, Washington, (which contract is referred to herein and is made a part hereof as though attached hereto), and WHEREAS, the said Principal has accepted, or is about to accept, the said contract., and undertake to perform the work therein provided for in the manner and within the time set forth; NOW, THEREFORE, if the said Principal shall faithfully perform all of the provisions of said contract in the manner and within the tinne therein set forth or within such extensions of time as may be granted under said contract, and shall pay all laborers, mechanics, subcontractors and material men, and all persons who shall supply said Principal or subcontractors with provisions and supplies for the carrying on of said work, and shall hold said Grant County harmless from any loss or damage occasioned to any person or property by reason of any carelessness or negligence on the part of said Principal,, or any subcontractor in the performance of said work and shall indemnify and hold Grant County harmless from any damage or expense by reason of failure of performance as specified in said contract or from defects appearing or developing in the material or workmanship provided or performed under said contract, and until the same is accepted, then and in that event this obligation shall be void but otherwise it shall bpm d remain in full force and effect. Countersigned. - N/A Licensed Agent/Surety Co. Liberty Mutual Insurance Company Surety Propel Insurance 601 Union Street, Suite 3400, Seattle, WA 98101 t 20 )676-4200 Firm, Street Address (No P,O Box), Phone of Local Office of Agent Approved as to form: 019 eputy P cuting Attorney '�CUti _4ke_ 'Ut' PC"" --- Deputy pmuity PPmoserctit uting Attorney Koact 5-NVV & U -NW Overlay Project, CRP 19-01 Contract --Page Liberty,Mutua SURETY This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY Certificate No: 8200930-023049 KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Holli Albers, Heather L. Allen, James B. Binder, Brandon K. Bush, Carley Espiritu, Jacob T. Haddock, Diane M. Harding, Brent E. Heilesen, Kyle Joseph Howat, Cvnthia L. Jay, Aliceon A. Keltner, Christopher Kinvon, Michael S. Mansfield, Jamie L. Marques, Erica E. Mosley, Annelies M. Richie, Sara Sophie Sellin, Donald Percell Shanklin, Jr., Karen C. Swanson, Misti M. Webb, Eric A. Zimmerman all of the city of Tacoma state of Washington each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 17th day of April , 2019 . Liberty Mutual Insurance Company \NSUR �Jv INS& \NSURq The Ohio Casualty Insurance Company �J �GO(tPOR,gT�yC� �J=GORPORgr�g2C' \GPS ORPORq�F -y�, West American Insurance Company � J o fi Q o o fi t� 1912 0 0 1919 0 2 1991 W r o o ACHUS� .da yAMIP � YS INDIANP as B David M. Carey, Assistant Secretary State of PENNSYLVANIA County of MONTGOMERY ss On this 17th day of April , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes = therein contained by signing on behalf of the corporations by himself as a duly authorized officer. LU IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. Q C: . ..... :xi „5'� 0 M l(l,`f�" 9 qe COMMONWEALTH OF PENNSYLVANIA Notarial Seal 4-0 Teresa Pastella, Notary O Public L Upper MerionTwp. , Montgomery County By: O My Commission Expires March 28, 2021 E yk,�J. Teresa Pastella, Notary Public O to " Member, Pennsylvania Association of Notaries CL O Cn O This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows. O a) ARTICLE IV - OFFICERS: Section 12. Power of Attorney. 3: Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the • .� President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety > o any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall 0 N have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such N instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the L cY) Lr— 00 provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. o 0 ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. U � Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, F shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 20th day of August , 2019 . \NSUR ��Y INSU \NSUR �J �0OpwoR,QT��C1 GjJ �GORPOR,4.r�-9`P= pRPORq��iC� Q• 1912 0 0 1919 0 2 1991 C-) r 3 � D 0 r9s ��y sti0 ,�`�� `� By: '4CHVS.da 0 1&YAMPS�,�� s /NoIANP dD Renee C. Llewellyn, Assistant Secretary LMS -12873 LMIC OCIC WAIC Multi Co 062018 Client#: 148076 CENT ASH31 ACORDrm CERTIFICATE OF LIABILITY I DATE (MMIDDNYYY) 811.9/201 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 AMENDS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE .A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL. INSURED, the policy(les) must have ADDITIONAL. INSURED provisions or be endorsed= If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Propel insurance Seattle Commercial Insurance ,�i'�'� Union St, Suite 3400 Seattle,, �A '� ►1 NAME: Joy Arakaki Arm Nc, Ext � 800 499-0933 At , Nti�; - 328 E-MAIL •,� .arakaki ro elinsuran�ce.con� ADDRESS; joy.a.rakak*i@propelinsurance.com � [NSUR.ER(S) AFFORDING COVERAGEI'�1�I+G INSURERA ; Zurich American Insurance Company 18838 INSURED Central Washington Asphalt, Inc. PO Box 939 INSURER B :American Guarantee and Liability 1ns.Ca 26247 INSURER C Moses Lake, WA 98837 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE. NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE. POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CE ANY CONTRACTOR 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 SHOW/ MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR TYPE. OF INSURANCE INSR SUBR ill VD POLICY NUMBER POLI DY EFF P�iLIOIR EXP LIMITS A X COMMERCIAL GENERAL LIABILITY GLA039838102 12/3112018 03131/2020 EACH OCCURRENCE: $11000,000 CLAIMS -MADE, ®OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 PD Ded: $8,008 MED EXP (Any erre person) $1 O,000 PERSONAL. & AD'S' INJURY $ I Y0001000 GEN'L AGGREGATE. LIMIT APPLIES PER: GENERAL. AGGREGATE $ 2,000,000 PRO - POLICY X JECT [7LOC PRODUCTS w COMPIOP AGG $21000,000 OTHER: $ A AUTOMOBILE LIABILITY GLA039838102 121'3' 12018 03/31/2020 Eaacciden SINGLE LIMIT $2,1001808 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS PD Ded: $10,000 BODILY INJURY (Per accident) $ HIREDNON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE 'Per accident)$ $ B X UMBRELLA. LIAR X OCCUR AUC03 8484 2 12/3112018 03/31/2020 EACH OCCURRENCE $1,000,000 EXCESS LIA.B CLAIMS -MADE AGGREGATE $I 9000YO00 DED RETENTION $ $ A D EMPS COMEMPLOYERS' GLA039838102 12/3112818 PER TOTH- X43#31 /202 STATUE ER LIIONLIT Ahilri EMPLQYERS' LIABILITY � � N ANY PROPRIETORIPARTNER/EXECUTIVE (WA Stop Gap) E.L. EACH ACCIDENT $1 000 000 OFFICER/MEMBER EXCLUDED' N ! A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $I NO,= If fires, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE: -- POLICY LIMIT $� ,�� DESCRIPTION OF OPERATIONS i LOCATIONS d VEHICLES: (ACORD 101, Addiflonal Remarks Schedule, may be attached if more space is required) The General Liability, Auto Liability and Umbrella Liability policies include a blanket automatic additional insured endorsement that provides additional insured status to the certificate balder only when there is a written contract between the named insured) and the certificate holder that. requires such status. RE: TA -667; Road 6 -NW & U -NW Project. TPR -G132(007). (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Grant County Public Works De pa rtrne Int 124 Enterprise St SE Ephrata, WA 98823 ACORD 29 (2016/03) 1 of 2 #S3781607/M 3888237 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logs are registered marks of ACORD JYAOO SAGITTA 25.3 (2016/03) 2 of #S3761607/M3666237 Additional Insured — Automatic — Owners Lessees Or Contractors THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREF LL Policy No. GLA039838102 Effective Date: 12/31/2018 ........... .. ... This endorsement modifies insurance provided under the: Commercial General Liabl"111ty Coverage Part A. Section 11 — Who Is An Insured is amended to include as an additional insured any person or organization whom you .are required to add as an additional insured under a written contract or written agreement executed by you, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" and subject to the following: 1. If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements, a. The Insurance Services Office (ISO) ISO CG 20 10 (10/01 edition); or b. The ISO CG 20 37 (10/01 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage." or "personal and advertising injury" arises out of: (1) Your ongoing operations, with respect to Paragraph Ia. above; or (2) "Your work", with respect to Paragraph 1.b. above., which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph I., insurance afforded to such additional insured: 4 0 (a) Only applies If the "bodily injury", "property damage" or "personal and advertising i . njury' offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (b) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the ""products -completed operations hazard" unless the written contract or written agreement specifically requires that. you provide such coverage to such additional insured, Solely with respect to this Paragraph (b), If the written contract or written agreement provides a minimum time period od for providing such coverage, and such minimum time period ends prior to the end of the policy period, this insurance shall not apply to "bodily injure"" ""property damage" or a ""personal and advertising injury" offense which occurs during the policy period and after the end of that minimum time period. 2. If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements. - a. The Insurance Services Office (ISO) ISO CG 20 10 (07/04 edition); or b. The ISO CG 20 37 (07/04 edition), U -GL -1 114 includes copyrighted material of Insurance Services Office, Inc., with its permission. Page, 1 of 4 such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injur)( "property damage" or "personal and adverti i + I V1 4 ising inju is caused, in whole or in part, by- ry (1) Your acts or omissions, or T (2) The acts or omissions of those acting on your behalf, in the performance of: (a) Your ongoing operations, with respect to Paragraph 2.a. above, or M "Your work" and included in the "prod ucts-completed operations hazard", with respect to Paragraph 2.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 2, insurance afforded to such additional ins ure& Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or writen agreement; and (fl) Does not apply to "bodily injury" or"property damage" caused by "your work" and included within the "prod ucts-completed operations hazard" unless the written contract or written agreement s 'fically requires that you provide such coverage to such additional insured, ped Solely with respect to this Paragraph (N), if the written contract or written agreement provides a minimum time period for providing such coverage, and such minimum time period ends prior to the end of the policy period, this insurance shall not apply to "bodily injury", "property damage" or a "personal and advertising injury" offense which occurs during the policy period and after the end of that minimum time period. 3. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you ridthatthat the person or organization be named as an additional insured: pov a. Under the ISO CG 20 10 (04/13 edition, any subsequent edition or if no edition data is specified), or b. With respect to ongoing operations (d no form is specified), , such person or organization is then an additional insured only to the extent that "bodily injury", "property damage" or �Ipersonal and advertising injury" is caused, in whole or in part by-, (1) Your acts or omissions, or (2) The acts or omissions of those acting on your behalf, in the performance of your ongoing operations, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 3, 'insurance afforded to such additional insured-, (a) Only applies to the extent permitted by law�- f (b) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and (c) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement. 4. If neither Paragraph 1. nor Paragraph 2. above apply and such wniften contract or written agreement requires that de that the person or organiz ab on you provide be named as an additional insured: a. Under the IS CG 20 37 (04/13 edition, any subsequent edition or if no edition date is specified); or b. With respect to the "products -completed operations hazard" if no form is specified), U -GL -1 114 Includes copyrighted material of Insurance Services Office., Inc., Wth its permission. Page 2 of 4 sJuch person or organization is then an additional insured only to the extent that "bodily injury" or "Property damage" is caused, in whole or in part by "your work" and included in the "products -completed operations hazard", which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 4., insurance afforded to such additional insured: (1) Only applies to the extent permitted by law-, (2) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; (3) Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (4) Does not apply to "bodily injury" or "property damage" caused by "your work" and Included within the "products -completed operations hazard" unless the written contract or whtten agreement specifically requires that you provide such coverage to such additional insured. Solely with respect to this Paragraph (4), if the written contract or written agreement provides a minimum time period for providing such coverage, and such minimum time period ends prior to the end of the policy 0 period, this insurance shall not apply to"bodily injury" or "property damage" which occurs during the policy period and after the end of that minimum time period, B. Solely with respect to the insurance afforded to any additional insured referenced in Section A. of this endorsement, the following additional exclusion applies: This insurance does not apply to " bodily injury" , " property damage" or "personal and advertising injury" arising out of the rendering of, or 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, C. Solely with respect to the coverage provided by this endorsement, the following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suft of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: (1) We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; (2) We receive written notice of a claim or "suit" as soon as practicable; and (3) A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. I D. Solely with respect to the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercliall General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. U -GL -,l 114 Includes copyrighted rinatedal of Insurance Services Office, I . ne, with its permission, Page 3 of 4 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition under Section IV — mm r i l General Liability Conditions. - This insurance is excess over., Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence, offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a. Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a. primary and non -contributory basis. E. This endorsement does not apply to an additional insured which has been added to this Coverage Part by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. Solely with respect to the insurance afforded to an additional insured under this endorsement, the following is added to Section III — Limits Of Insurance: Additional Insured — Automatic — Owners, Lessees Or Contractors Limit The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement. referenced in Section A. ofthis endorsement; or 2. 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. All other terms, conditions, provisions and exclusions of this policy remain the same. -G-L-1 114 Includes copyrighted matenial of Insurance Services Office, Inc,, with its permission. Page 4, of 4 POLICY NUMBER GLA039838102 AW; This endorsement modifies insurance provided under the following. - COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL GENERAL UADLlrl CG 25 03 05 OA A GENERAL AGGREGATE LIMIT APPLIES TO EACH CONSTRUCTION PROJECT WHERE THE NAMED IUSURED IS PERFORMING OPERATIONS HOWEVER,, A GENERAL AGGREGATE LIMIT DOES NOT APPLY TO ANY CONSTRUCTION PROJECT WHERE THE NAMED INSURED IS PERFORMING OPERATIONS THAT AP2 INStMD UNDER A WRAP UP OR ANY OTI4ER CONSOLIDATED OR SIMILAR INSURANCE PROGRAM .................. .. . ... d --- - -------------- ---- CG 25 03 05 09 .. ......... .. ..... . ............ ...... �pw 4�� 4It�4*6 4�4.� o �40"R . ....... . ..... to g Tw—n—'ab—oy�ew� 0 Insurance Services Office, Inc,, 2008 An p ?. 0 Cn Inu ltage I of 2 13 GLA0398381 01 0 � � �'� IIty I rl h 'prod ucts-completaird operations hazard" is Cut n �� n W-01"bodifly _ .0. uwill provided, any payments �� because of injury" or "property damage" Included In 49. Ion, an the "products -completed operations hazard' W. M �� : � �� reduce the roducts Operations ,1h 01, Aggregate Limit, and not reduce the General -° Aggregate Limit nor the Designated Construction 1 . �� Project General Aggregate Limit. .r arn� r r e o for.i 1 D. I the applicable designated construction project expenses shall reduce the rout. ilhl has been abandoned, delayed, r abandoned li n�°° rr� �. r the h restarted,° l h authorized � M er b r eat contracting parties deviate from plans, blueprints, ,°°� ,h�her�:::�� designs, i or timetables, r 2. 804chlr h 11 � :j will ll h deemed he the construction . C n� rution fir . General project. �rA E« The provisions Section l l -..m Insurance n of otherwilse modified by Chi's endorsementshall confinue to apply a stipulated, Page 2 of 2 0 Insurance Services office, Inc., 2008 CG 25 03 05 09 E3 Waiver Of Subrogation (B*lanke Endorsement ZURICH.- -- --- ----- .... .. .......... ............... . .. ........ Policy No... Eff Date of Pol. Exp, Date of Pol, Eli'. Date of End Producer AddT.Prem Return Prern, GLA039838102 1213112018 Propel InWrance ....... ... ..... ...... A44 .... ....... THIS ENDORSEMENT CHANGES THE POIACY. PLEASE READ IT CAREFULLY. Thi's endorsement modifies insurance provided Linder the-, Commercial General Liability Coverage Part "I"hefi.) [lowing is added to the Transfer Of Rights Of Recovery Against Others "T"o Us Con(fition: If you are requ-ired by a written contract or agreement, Which is executed before a loss, to waive your rights of recovery from oth- we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in is the 'Insured has no contractual interest. U -CIL -925-B CW (t2/01) Page I of I ... ... . . . . . . . . . . . . . . ... . . . . . . Policy No..", I Eff. Date of Po L Exp,. Date of Pol. Eff,..Date of End. Producer No,. Addl. Pr*em Return Prem, GLA039838102 12/31/2018 . .. ..... --------- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form Fa =-f M 1. The following is added to the Who Is An Insured Provision in Section 11 — Covered Autos Liability Coverage: The following are also "insureds", a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you, Any "employee" i of yours s also an "insured" while operating an It auto" hired or rented under a contract or agreement in an 64employee'spf name, with your permission, while performing duties related to the conduct of your business, b. Anyone volunteering services to you is an "insured" while using a covered " auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.I.a. and A.I.b. in this endorsement, d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. n 2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form -k Coverage for any person(s) or organization( )4 where required by written contract or written agreement with you executed prior to any "accident', will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment— up lament r ments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section 11 — Covered Autos Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of ball bonds (including bonds for related traffic law violations) required because of an 0'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. U -CA -424-F CW (04-14) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 6 C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section 11 — Covered Autos Liability Coverage does not apply, =piiii ig�lpipqqqqg� 1. The following is added to the Racing Exclusion in Section 11 — Covered Autos Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility del onstraticns, 2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations, �to Lease or Loan Ga, The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered $$auto", less: a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and b. Any: (1) Overdue lease or loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage, (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease: and (6) Carry-over balances from previous leases or loans. Paragraph A.2x of the Physical Damage Coverage Section is replaced by the following'. We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible shown in the Declarations will apply, However, if glass can be repaired and I s actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced, H. Hired Auto Physical Damage — Increased Loss of Use Expenses The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "Insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement, We will pay for loss of use expenses if caused by: U -CA -424--F GVV (04-14) Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered ifeuto" i (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto''. However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000. The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to $760 for "loss" to personal effects which are: (1) Personal property owned by an "insured"; and (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of: (1) The reasonable cost to replace, or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered ;auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; Jewelry, watches, precious or semi-precious stones, (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph BAa.. of Sectilon III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion In Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply. 2. The following 'is added to Paragraph i,.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "Insured"- and (b) Are in a covered "auto" at the time of "loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". U -CA -424-F CW (04-14) Page 3 of 6 includes copyrighted material of Insurance, Services Office, Inc, Mth hs permission..: K. Airbag Coverage The Exclusion in Paragraph 13.3-a- of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph 8.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you by us, the following applies for each covered Uautd'on a per vehicle basis: 1. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. M. Physical Damage - Comprehensive Coverage - Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered " autos" damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss" from any one cause is $6,000 or the deductible shown in the Declarations, whichever is greater. A. Temporary $ubstitute Autos - Physical Damage 1. The following is added to Section I - Covered Autos: 0 Temporary Substitute Autos - Physical Damage If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos"t the following types of vehicles are also covered "autos" for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered k '"auto" you do own but.is out of service because of its ��- 1. Breakdown', 2. Repair; 3. Servicing; 4. "Loss"; or 6. Destruction. 2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section'. Temporary Substitute Autos - Physical Damage We will pay the owner for "loss" to the temporary substitute "autd' unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" It replaces. 0. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of "accident", claim, "suit' or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner if you are a partnership), a member (if you are a limited liability company) or an executive officer or insurance manager if you are a corporation). The failure of any U -CA -424--F CW (04-14) Page 4 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. agent, servant or employee of the "insured" to notify us of any ""accident`", claim, "suit" or "loss" shall not invalidate the insurance afforded by this policy. Include, as soon as practicable& (1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident" i Claim 4`suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against them To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. 0. Employee Hired Autos — Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "auto$" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that ovemployee'sil employment by you or that elected or appointed official's duties as respect their obligations to you. However, any "autd'that is leased, hired, rented or borrowed with a driver is rot a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition'. However, we will not deny coverage under this Coverage Form if you unintentionally'. (1) Fail to disclose any hazards existing at the inception date of this Coverage Form, or (2) Make an error, omission, improper description of "autosf' or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto —World Wide Coverage Paragraph 7a.(S) of the Policy Period, Coverage Territory Condition is replaced by the following: (6) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, T. Bodily Injury Redefined The definition of "bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. U -CA -424-F CW (04--14) Page 5 of 6 Includes copyrighted material of Insurance Services Office, Ing., with its permission. U. Expected Or Intended Injury The Expected Or Intended bury Exclusion in Paragraph B. Exclusions under Section 11- Covered Auto Liability Coverage is replaced by the f llowin � Expected r Intended Injury "Bodily injury" or "property damage" expected or intended from the -standpoint of the "insured". This exclusion does not apply to "bodily injury" r '"property damage" resulting from the use of reasonable force to protect persons or property, Paragraph AA.a. of Section Ill - Physical Damage Coverage is replaced by the following: a Coverage Extensions a. Transportation Expenses We will pay up t. $50 per day to a maximum X000 for temporary transportation expense incurred by you because of the total theft of a; covered 'auto" of the private passenger type. We will pay only for those. covered "autos" for which you carry either 'Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours afar the theft and endings regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its loss'. W. Replacement of a Private Passenger auto with a Hybrid or Alternative Foal Source ,auto Th following ll in is added to Paragraph . Coverage of the Physical Damage Coverage Section: In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or "auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost. f the replacement "auto", excluding tax-, title license, other fees and any aftermarket at vehicle upgrades, up to a maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative fuel source within 60 calendar days ofthe payment of the "loss!' and evidenced by a hill of sale or new vehicle lease agreement, To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of propulsion power. The ether source of propulsion power must be electric, hydrogen, propane, solar or natural gas, either compressed or liquefied. To qualif. as an "auto" powered by an alternative fuel source, the "autos" must be powered by a source of propulsion power other than a• conventional gasoline engine, An "auto" solely propelled by Motel, gasoline or diesel fuel or any bland thereof is not an "auto" powered by an alternative fuel source. X. Return of Stolen Automobile The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section. - If ection.I e covered "auto" Is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay only for those covered Atautos" for which you carry either Comprehensive or Specified Reuses of Loss Coverage. All other terms, conditions;" provisions and exclusions of this policy remain the sane. - A-4 4wF CW (04--14) Includes copyrighted material of Insurance Services Offirm, Inc,, With its permission, Page 6 of 6 GRANT COUNTY PUBLIC WORKS DEPARTMENT Jeff Tincher, P.E. Ed Lowry Director of Public Works and CO Supervisor County Road Engineer Road District #1 Ephrata (5091) 754-6082 e, rr Ephrata (509) 754-6586 ' - Ti, Jerome Wawers Mike Detrolio, Supervisor Assistant Director of Public Works ;'X Road District #2 Ephrata (509) 754-6082 Moses Lake (509) 765-4172 77 Bob Bersanti John Brissey, Supervisor Design/Construction Engineer Road District #3 Ephrata (509) 754-6082 Quincy (509) 787-2321 Jason Collings, Supervisor Andrew Booth Supervisor Solid Waste Bridges Ephrata (509) 754-4319 Ephrata (509) 754-6082 LL OPWASVIA 1 19. M 4:1 For Construction of: Road 5 -NW & U -NW Overlay Project CRP 18-01 Sealed Bids will be opened on August 6, 2019 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 "ROPOSAL To: Board of County Commiss' jonersDafie. - August 6 -,-, 2019 Grant County, Washington eXaM4 This certifies that the undersigned has ined the 10cation of Road 5-NW & U-NW Overlay Pr 01 "ect,,,, CRP 18-01, 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 the made for said work Is understood. The undersigned hereby proposes to undertake and com I plete 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 foil of rates and prices. Owing schedule Road 5-NW & U-NW Overlay Project, Note.,, Unit prices for all items., all extensions,, and total amount Must be shown,, Please ty e or use ink. Pleaseinitial all changes, ...... . .. . . .................. Plan "a Item Plan Item Description Price per Unit* Quantity It* Total Amount LNO.- Quantity 0 1 ts Dollars. Cents Dollars . ....... Ceents PREPARATION obilizati M i ion At Lump Sum IIH114111 99;354.,86 Per Lump Sum GRADING 2 17.68 Mile Shoulder Finishing HOT MIX ASPHALT 3 18 '0010 Planing Bituminous Pavement S,Y. 4 22.�900 o Fn —T on HMA Cl. Y In, PG64-28 5#uJob IIx Cornplianc'e Price Adjustment 6 Calculated Compaction Price Ad' Justment oad 5 -NW & U-NW'0Ve--r1ay Project, C --R-- 0-1-8--0-1 At 6,500.00 Per Mile 114;920*00 At 2 * 25 40 Per Square Yard ,522-650 At 70 tOO 603., 000* (0o Perron At oo At H1111111,11111 -",-1.00 Calculated age .. . Plan * itemI ton Price per Unit* TOte-1 Amo --- Item DescHpu L No. Quantity 1'c ars C unt J:Doffars TRAFFIC Dollars. Cents 2J26 Remove Existing Beam Guardrail FAt 5 4c 00 lea ,63OvOO L Per Linear Foot 11529 Beam Guardrail Type 31 At 23 *00 35,167*00 Per Linear Fo t Lin. F9tJ. 9 6 Beam Guardrail Type 31 Non- �At Each FFlared Terminal 50t-01 W/ Steel Posts 31300,00 19,1800 *00 Per Each 10 14 Beam Guardrail T' pe Y 31 Anchor At Each Type 10 lj2004OO Per Each 16,800400 OQ5 14,650.00 - ------- Per Linear FootT 12 138248 Paint Line At Oo18 24,884,64 Per Lfnea-r Foot :)50,,]00 �3 7248 Paint Lin, Lin . Ft. 0'018 34o 64] LPe r Foot At Per Linear Foot Lin, Ft.7�� Ic Stop Bar At 13%00 468,00 Per Linear Foot 151 7183,84Centerline RumbJ-e--S------' At trip M Mile He 11200 00 10�608 00 Per Mile fAt 12( Per i 16 17M Shoulder Rumble Strip Mile At 1,0100400. 19,448400 17 Project Temporary Traffic Control At Lump Sum Per Lump Sum oad±-NW &U4NVV & age Item Plan No. Quantity OTHER ITEMS F-1 T 21 Each Item Description Price per Unit* TO tal Amount. 1 Dollars. 0ents Dollars Cents Adjust MonumentCtase and Cover At 450*00 Per Each 19 1 SPCC Plan At Lump Sum - -------- Per Lump Sum 20 1 1 Trimming and Cleanup Lump Sum 2.1, 1 Calculated I Minor Change 9,450t 00 1,1000-00 At Ill/IIi/l.l0lll 2,500. 00 Per Lump Sum At -$1,100 Calculated PROJECT Total $2,118,000.00 oad 5 -NW & U -NW Overlay Project, CRP 18-01 Page with Wage Paymcnit Stats The bidder hereby certifies that, within the three-year period iMmediately precnd- bid solicitation date (5/7/2019), the bidder is nota "Willful", V101atoe I-_ ing the F, as defined In RCW 49-48-082, of any provision of chapters 49.46, 49+48, or 49.52 CW, as determined by final and binding citatind on anotice of assessma ent issued by the Departmentof Labor and Industries or through a civil judgment entered by a Kerte flimited or general jUrisiction. I certify under penalty of perjury under the laws of the State Of Washington that the foregoing 'is true and correct, Central Washington Asphalt, Inc. Bidder's Business N S;* atu. fAuthorized Olficial* Pamp Maiers Printed No -me President Title 8/6/19Moses Lake WA Date City State Check One4- Sc,le Pl-oprietorship E Partnership Li Joint Venture 7_1; Corporation State of incorporation, or if not a. corporation, State where business entity was formed. - Washington If a cc -partnership, give firm name Under which business I's transatted: N/A t.. If a corporation., PrOPOS01 must b` executed in the corporatename by Ar the President or vice-president or any Other corporate officer accompanted by evidence Of authority to sign). If a co -partnership, proposal imust be executed by a partner, R o a d 5- N W & U -NW fieri pr C R P f 8--o' Page Failure to return this Declaration as part of the bid proposal package will make the bid nonresponsive and ineligible for award. 1, by signing the proposal., hereby declare, under penalty of perjury under the laws of the United States that the following statements are true andcorrect.- 1. That the undersigned person(s), fi A A rni,, association., or corporation has (have) not, either directly or indfrectly, entered into any agreement., participated in any collusion) or otherwise taken any action in restraint of free competitiveWdd4 with the project for which this proposal is submitted. i ing in connection 2. That by signing the signature page of this proposal, I am deemed to have signed and to have agreed to the provisions of this declaration. To report rigging activities call: F,a, The U,S. Department of Transportation (USDOT) operates the above toll-free '"hotline" Monday I I no e through Friday, &00 am. to 5M p,m,, Eastern Time. Anyone with k wl dge 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 investste highway construction contract fraud and abuse and is operated under the direction of the USD0T Inspector General. All information will be treated confidentially and Caller anonymfty w,11 be respected. Road 5 -NW & U -NW Overlay Project, i Page r o p o.. dk- g n ai It. u !, e rP a g e The bidder i'--'$ hereby advised that by signature of this pi-oposalhe/she i -s eerred to hCave 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 a appiroximpries and in estimate of quantities at the above n the form as indicated below is attached hereto.- s Cash In the Amount" of Cashier -'s Check El Dollars t..efrtffied Check 0 Payable to the Grant County ire asuirer Proposal Bond N, In the Amount of 5% of the Bid -y Receipt- is he.. ec anowi dge of addendum(s) No.(s) - 0 Signature of Autho-2ed OffiI cialts) PrOPOW Must Be Signed Pa p Maiers, President Please Pr2'nt Name of Authorized Officj,j cj'$ Firm Name Centrai-Mashington Asphalt, Inc. Address P.O. Box 939 Moses LakeWA98837 State of Washington Contraf-"ttorls License No. CENTRWA181PG Federal ID No. 91-1178142 This Proposal form not tran.-fera" le and an'Y ailteration entered hereon withoutPricr Pernrtis-on fnotr t�,e counfy -N Engineer will be cauSe for considerin.9 Proposal irreguiar and subsequent re-fection of bid. 2) Rease refer to section 1-0016 of the stancloard spedficationsre.'2 Preparation, ofPrOPOSaj" or "'Artide 4" or il"ISITuctions to bidders for buH 'ing �:ons+rtjct-o (3) Should it be nec' I C. L i� q iobs' the I , fly 1 �-es':3ry tO Mod' this Protocsa! either e Tinting mr by e1e*'---*fron'i, 1.03 , z-%� - M3ke rnfere"-Ice t in Your comrnunicat- llow�ng proposal nurnber ' �OM U Revis-ed 8/95 cad 5 -NW & U -NW — 4* oven Z– a Y P r o5j-e c t. R F�1-1�-O