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Home My WebLink About14-026 - Iron Creek Construction - 2013 ADA ImprovementsCITY OF TUKWILA CONTRACT CHANGE ORDER NO. 1 Sheet 1 of 3 DATE: PROJECT NO.: PROJECT NAME: TO: 07/16/2014 BUDGET NO.: 104.98.595.800.65.00 91210405 CONTRACT NO.: 14 -026 ( ) 2013 ADA Improvements Iron Creek Construction, LLC. Atten: Nathan Dodson, Member You are hereby directed to make the herein described changes to the plans and specifications or do the following described work not included in the plans and specifications on this contract: NOTE: This change order is not effective until approved by the "Owner" and a notice to proceed is issued. Conditions: A. The following change, and work affected thereby, is subject to all contract stipulations and covenants; B. The rights of the "Owner" are not prejudiced; and C. All claims against the "Owner" which are incidental to or as a consequence of this change are waived. D. The Contractor Must Submit all Field Overhead and Home Office Overhead rates for approval in advance of all Change Orders. CHANGE: Electrical changes to remove and relocate traffic signal junction box out of the ramp at 35t'' Ave S. and replace approx. 20' of the ramp including landing to accommodate ADA requirements. FD #5 is the field directive for this work. This change will be compensated as Bid Item #2 Minor changes. We the undersigned Contractor, have given careful consideration to the change proposed and hereby agree, if this proposal is approved, that we will provide all equipment, furnish all materials, except as may otherwise be noted above, and perform all services necessary for the work above specified, and will accept as full payment therefore the prices shown above and below. ACCEPTED: Date By Original Contract Previous Change Order (s) $ This Change Order (including sales tax Rule 171) Mayor // AMOUNT 86 450.00 " Includi • Sales Tax (rule 171 EV. CONTRACT $ ( 171) I RIGINAL: City Clerk (1 of 2) Contractor (2 of 2) Contractor 3404 Ce.r.61t Cmistavivi jof CU.. / Title 0161 Ben - 84,450.00 • APPROVED BY THE CITY OF TUKWILA 0.0 Date 'By2,000.00 1'5/6,04 p2 c/216/.09,--s- cc: Finance Department (w /encumbrance); Construction Inspector; Construction Engineer; file: CITY OF TUKWILA PUBLIC WORKS DEPARTMENT 6300 Southcenter Boulevard. Suite 100 Tukwila. Washington 98188 Phone: (206) 433 -0179 FIELD DIRECTIVES Attn: j e Date: (41 -.21 Project Name: LL-e, ,2Cr i.3 Aid IA 1).4• �' 0N ►* Project No.: (�l 1c 'IC? Contract No.: f Work to be performed: RV-TIN-4,x_ c1ArAty. Lk. "4►" c•�� new ('t \-' cle,t i 1-zt, /-1 e`v�. ' • ' e .t..&€t- ; t1 i'�+'�.t t- Reason for modification: . VC. '�il`aZ.l :.Y tl �'•�4- 7:r'- c.�l�`i ~� c'rt.�a •iL'. ` +1:�'� _iii l �. 1 i s A- , Work under this Field Directive modification will be accomplished: • With no change to the contract price. j For a lump sum increase /decrease of _ _ _ to the contract price. j On a unit price basis with a maximum allowable increaseidecrease of )J With work to start immediately and determination of any thane to.the contract price and /or completion date to be negotiated. Negotiations to be complete by .�_' (,..1''Z _ 2 'L� _ .__„_ within a reasonable time. 'NVi With no change in contract completion date. u With no contract completion date extended /decreased ______.._ calendar days. Performance of this Field Directive is authorized by all signatures below: Accepted by: Approved by: Verified by: 41 Contractor's Rep — Name M etAX 1 16 \iii Date /it( Title inLIN City Construction Engineer City Construction Inspector G•I- Date "'rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale Iron Creek Construction LLC LIC #IRONCCC874MN 22525 SE 64th PL Suite 2228 Issaquah, WA 98027 Phone: (425) 557 -5927 Fax: (425) 557 -3605 CHANGE ORDER PROPOSAL Customer Name: City of Tukwila Date: June 25, 2014 Project Name: 2013 ADA Improvements Project No: 91210405 Scope of Work: Price: Remove approximate 40 sf of concrete ramp and pedestrian curb, excavate and move Traffic Signal box from ramp approx 3' into planter with appropriate conduit and additional wire /splicing as needed Repour ramp and pedestrian curb Subtotal Tax (9.5 %) Total $ $ $ , 0.00 (9 tvo ic- , 0.00 N/A 3,00.6.00 Acceptance of Proposal - The above prices, sepcifcations and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined. Signature: z/ -E --- Date of y� f' Acceptance 'I/ W t,�,1htL( Signature: 7191v O i Y ed5471 t(,V t-- Contractor Owner C -1 AGREEMENT FORM CONTRACT NO. 14 -026 Council Approval 2/3/14 THIS AGREEMENT is made and entered into on this ✓ day of 1 , 20 14, by and between the City of Tukwila, Washington ( "Owner ") and -pick( CULEEK- CoNsTy ie.. ct.( QC. ( "Contractor"). Now, therefore the parties agree as follows: 1. Project. Contractor shall complete all work and furnish all labor, tools, materials, and equipment for the project entitled 2013 ADA Improvements, Project No. 91210405, including all changes to the Work and force account work, in accordance with the Contract Documents, as described in Section 1 -04.2 of the Supplemental General Requirements. 2. Payments. Owner shall pay Contractor at the unit and lump sum prices, and by force account as specified in the Proposal according to the Contract Documents as to time, manner, and condition of payment. The payments to Contractor include the costs for all labor, tools, materials and equipment for the Work. 3. Completion Date. Contract time shall commence upon Owner's Notice to Proceed date. The Work under this Agreement shall be completed within the time specified in the Proposal. If the Work under this Agreement is not completed within the time specified, as detailed in the Contract Documents, Contractor shall pay liquidated damages and all engineering inspection and supervision costs to Owner as specified in the Proposal. 4. Attorney's Fees. In the event litigation is commenced to enforce this Agreement, the prevailing party shall be entitled to recover its costs, including reasonable attorney's and expert witness fees. 5. Disclaimer. No liability of Contractor shall attach to Owner by reason of entering into this Agreement, except as expressly provided in this Agreement. 6. Counterparts. This Agreement is executed in two (2) identical counterparts, by the parties, each of which shall for all purposes be deemed an original. CITY OF TUKWILA, WASHINGTON (Owner) City Clerk Approved as to Form: City At orney Address for giving notices: b&D -51∎6Q SSE (00 ltl�.W11c. Itii�} 61&0 2013 ADA Improvements �tc`M Ci cL. 001 j51 riuc t G f 1 LL (Contractor) Title: Attest: This %S day of Fejpd'<.tceti , 20 1%.I Contractor's License No. DLO CCLei4m,1 Address for giving notices: zz52.5 z-zze AJP-i,c vv- 47b 0277 / 5 /c)d 6/2j6 //VA S Rev. 12 -6 -13 O 5•vrF E d E' AND PERFORMANCE SOND .. ............ ................ ..... ... .. ............ .. .. .. ............ .. .. .. .. ......... S,O['id: f;: 4£ :u3: Ti €<udi €« ','pia: Nugio ... .. 3 to o,. ;31.515191 : u4Ks..: Iron Creek: Construction, LLC : ; :. WESTERN SURETY COMPANY South Dakota rCry� ?t';;Frf; 1£3Gi :a 5iety 00tpCti il0t3 ii tCri o #�cta.e ..Y1 (:.r. ?'itir,u.:#£"st';i.w`th: •3'Furitc33pO) c a hI£l » f"F �i�t #, .�f� tSiCi�y >- i 76Ve£aitj ifu ti I3 F :: : , 'i #:p :: { f :f3�i�{Y £, ;: lf s �� EF >, f ti. ..:: ie`£3srr ,:<< in .:: the:; :p fiat: atffi3: t3'c. Eighty Four Thousand Four Hundred Fifty and no /100 • • • • • • • •3j € €fi ;�; 84;450.00 th- r:WI en os# s rh h slum; oil' demand:. we hind evise ve and our s: L .e $,TA:: s, hhetrS; ,xecA st ior s pei on l rep reser 34fe, ps tsp 1113.S ue p• y: t< cr Fi 1Mffu f3#ar £ t; Bond i $ ��w e -the performan c •.• N r..: it oponeaion. wit t:i?rtrz' it tf3t February 19 .. f s14 . btw er? Est ;se al.ard.O;a:rFer.fer.a ?rc3jeot. • Wrrt=:tli n:: 2 1 ADA 1# :pruV:6m nts ,. Ccl?-F rant. t p. t "rf rfsrt£Ct" , € e rfsti € penal: Burr 1t E3 u•Oi 1O,% • $ the I eI :n.c;: „rthoq aait 5- t (, c33 k)e6.fieki i1 • the :Propa£a : to e?Ettt� Payr.utot and Petfernonoe.. 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Ftf '` .E• t ;t 1Ft: Fiir, it 4;3 n c,Ltt " r f <sJE3C r3 s -oil& frirtu'#£E^•,q:%j3'c'S i~q. d3rf1xige 'anti t3FE "iit3r ifi Ei ? "iE3 rE:�4f31fir3i 1fJEi3 arty' :deftarct a pt:Fpttt s?rt 3FF" O tf tt3pinti provide d ,i«rkr ariaY3ip i rfs3r -led ji�si r t1••? <rur ti c Ttie i' i3:tf tE3ruF%3 i ss Owref ,?:a11••a so i; ure: to•3t3e beriefit O •th, is. i)F?`st3lt:f? '_t3<tirlf?3rfi §: drif, stt•i?£ • 1 s ..G, ` gl;elA i.,;lr e,11%-; rtiilaff 34'd t,v.:iXvrtar:;PI r3jrgleCtiClF'31,Ss'fr; th° Prt, f,'i'•t tzi£3:tiii . 513r i rematrs :ttl .eft :t,;0: t #.< i8Ei ep'ta- of :tile Corjtract at ter:: t k Et f3res t `��r�. rt tttp :: t0x, t:) irf>iff$? 1 tpi4 : _e11 t'Yifzrr %s o d:: t;;orre,_; ,:,Cd?'l e t:FFEst #e{' in Hie E31t3Y,F3'it3E t33'E?v ;' rwfu G% w:; sF" t. i' !';,rx::at:,:O.:�is;f'ICE'£i3�. 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'.tn r„- -har? e., ext t7.- i : :Of :t E : :attefs71.twiif3:; Cans u` # >??. ut1tY c.t rr to ti Work :to:: r .).:t3.`Ef 3rE i'�: E3 "1t# ":tt3 :=M;f rffr t t at3zsi3 :irt c2 way :t tfi'i t .�0:etye:.rat34t ti f 0, } 910 Pa :yitierr':Mid:: ;awr.a srs .. . t3�r�1ay �a;�tsr=?s �ir�tftt e€ any �:1�EarEt�e. ?~Easi : +.)r: E}g 't €?-FEl tfil:ecaicn, or • tt e.`r.43`£?A: 5 F° t?3? t <Oott U; .e)£ .ti:t Work; r ; ith t h e exom3.i n f 3ei Surety &h 1 i'oti1)'''3 VIE, OntraCt r•$ :extended b riot, 1 Ear N:eft,: r-s C9 Payment 8, Performance Bond .. ............ .. .. .. .. ............ .. .. .. ............ .. .. .. t v£3S ? iLf� fi. fir£ if1 f i fxs'i�s' 33 ff"£'f' ss t &?: tot-s# . t?3`£3 >£3Tf ?Ct ti3}a 00 Jr,3PEf t# i a3.t&1 r'J f tht5:Payry#'f arrc Pe:'farrfnr' nce nj emu. tE : E 3t 2 `i) >^3` ':E? f3 � 3 f 73t3£iZf Yi`::tf'�i!: pct :3r �i.t33f t"`f,rtocrrt: ixif? ikisw£Fi of Suff`tyj; .. .. • . .. .. .. ffS ' 3rrfr i} i3 rid Pc.,,i srrn sn:,- ;e : :Sor d shaft Pie :9o:iC'Yr:£3s £ t—t:9 : : E33 ;vs of:t e SStt#?.fj%:: F 1 53Eff3 I3 f`•; i'iii irE:F'f33 T# £ bC # ft fpa 'f N:' tZ� +£`l %tm ✓ .. tr�� s;.<' ti3 ti2r t?%--rtte it£ev F;Y4' ?r #E } ( this 1);fv_o (2) £3t U3 •.`ci tt �3r�:'.. It6 : 21st : February 2 14 Iron Creek Cons IS . n LLC of rs:f.t:h£.r:izsi ; tt'3C.._# 111°IP 3 r•%#e MfIcj • w£ 5':c33i£i£3rrti3fff : iert ";<:iYftiSi:`l: W ERN SURETY COMPANY • '; : PAUL D BORDELON : : At ry ZF. (?£ ?f a£:rr# i ):4/0 rtf mYJrr:� y E .. BORDELON INSURANCE.: .3801 1•50TH AVE: SE STE. 300 BELLEVUE . WA .98.006 -1668 ... ,'£:kre.S ::3lffE'i : :?f2 1Z4f+ F W ff U?Sr3 +! y2(- {rif »Y:y'li1lf';[.4 •'>:'f£L.�i f -4a. i t s£ n i ?7r.!<;fffS(''_�3 {rt t rft?f::. .. .. .. ... .. ' - ' 12-F-t 3 STATE OF COUNTY OF Washington King On this c1Si- day of and for said County, personally appeared } ACKNOWLEDGMENT OF SURETY (Attorney -in -Fact) Bond No 71515191 PAUL D BORDELON , before me, a notary public in to me personally known and being by me duly sworn, did say, that he /she is the Attorney -in -Fact of WESTERN SURETY COMPANY, a corporation of Sioux Falls, South Dakota, created, organized and existing under and by virtue of the laws of the State of South Dakota, that the said instrument was executed on behalf of the said corporation by authority of its Board of Directors and that the said PAUL D BORDELON acknowledges said instrument to be the free act and deed of said corporation and that he /she has authority to sign said instrument without affixing the corporate seal of said corporation. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal at Bellevue Washington t : nd year last above written. sl My commiso exp es , � l /�' Or- Form 106 -9 -2013 otary Public Western Surety Company POWER OF ATTORNEY - CERTIFIED COPY Bond No 71515191 Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company "), does by these presents make, constitute and appoint PAUL D BORDELON its true and lawful attorney(s) -in -fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its behalf as Surety, bonds for: Principal: Iron Creek Construction, LLC Obligee: City of Tukwila Amount: $500,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s) -in -fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." All authority hereby conferred shall expire and terminate, without notice, unless used before midnight of June 5 2014 , but until such time shall be irrevocable and in full force and effect. In Witness Whereof, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its corporate se,,41t -affixed this 21st day of February 2014 ST.F474.4-aclUTILI:PWTA COUNTi€. ]Z:l ::?F iAHA } ss On this 21 s t day of February ,in the year 2014 , before me, a notary public, personally appeared Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act and dee f said co at on +bbrorobrorororobbbbbbbbrorobrorobb + • S. PETRIK • NOTARY PUBLIC SEAL ' + • SOUTH DAKOTA a +bbbb444bbbbbbbbbbbbb%%% + My Commission Expires August 11, 2016 I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof, I have hereunto set my hand and seal of Western Surety Company this February 2014 WEST.' R►. SURETY COMPANY Paul T. ruflat, Vice President otary Public - South Dakota Form F5306 -8 -2012 WEST 21st day of SURETY COMPANY Paul T.7ruflat, Vice President ACORO® CERTIFICATE OF LIABILITY INSURANCE L.---- DA's` 'DD"""' 02/24/2014 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 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 Bordelon, McCluskey & Sefton, Inc 3801 150TH AVENUE SE, SUITE 300 Bellevue, WA 98006 License #: 142376 CONTACT Paul Bordelon PHONE FAX (A/C. No. Ext): (425)455 -2227 (Ac, No): (425)653 -3030 E-MAIL ADDRESS: info@bordeloninsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Ohio Security Insurance Company 24082 INSURED Iron Creek Construction LLC 22525 SE 64th PI Ste 2228 Issaquah, WA 98027 INSURER B: Ohio Security 24082 INSURER C: 07/15/2014 INSURERD: $ 1,000,000 INSURERE: $ 1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 00009873-0 REVISION NUMBER: 14 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POUCY EXP (MM/DDMYYY) UMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y BLS55511980 07/15/2013 07/15/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISES O(Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 $ 2,000,000 $ 2,000,000 $ GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: I POLICY I X I TINT I I LOC PRODUCTS - COMP/OP AGG B AUTOMOBILELIABILmr X X ANY AUTO ALLOWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y BAS55511980 09/16/2013 09/16/2014 (COalINEDnSINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LAB EXCESS UAB - OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 5 yyes describe under DES(.)RIPTION OF OPERATIONS below N / A BLS55511980 07/15/2013 07/15/2014 X To RYLAMRS ER EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 A WA Stop Gap Y BLS55511980 07/15/2013 07/15/2014 $1171/$1M/$1 m DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) The certificate holder, City of Tukwila, its officials, elected officials, employees, agents, engineering consultants, construction management consultants and volunteers are named as additional insured with respect to the insured's operations for all jobs performed per contract CERTIFICATE HOLDER CANCELLATION The City of Tukwila 6200 Southcenter Boulevard Tukwila, WA 98188 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTOO DREPRREESENTAT VE 0/y� (PDB) ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by PDB on February 24, 2014 at 12:22PM COMMERCIAL AUTO CA 88 10 01 10 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. COVERAGE INDEX SUBJECT PROVISION NUMBER .1 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE - BROADENED COVERAGE GLASS REPAIR - WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS . WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION 11 - LIABILITY COVERAGE is amended as follows: 1. 3 12 18 5 13 1 21 2 22 10 15 6 20 14 16 11 8 9 4 7 17 19 BROAD FORM INSURED SECTION 11 - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self - insured retention plan available to that organization; CA 88 10 01 10 02010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of insurance Services Office Inc., with its Permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. -. WHO IS AN INSURED is amended to include the following as an insured: f. 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 endorse- ment is excess over any other insurance available to any "employee ". g. An "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 re- lated 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 ". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: h. 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, 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 agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION 11 - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (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 Toss of earn- ings up to $500 a day because of time off from work. 5. 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 provision is added: SECTION 11 - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - 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 CA 88 10 01 10 ©2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 2 of 7 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 $750 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 ". For the purposes of this provision, SECTION V - DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION 111 - 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, "light truck" or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks ", we will pay up to $50 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. 8. PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION Ill - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 CA88100110 032010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc., with Its Permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. 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 expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 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 ". 8 3 8 d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. 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 Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION Ill - 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. 11. 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 securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION 111 - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: 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 over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION 1Ii - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: CA88100110 02010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment Is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto "; or 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. 14. LOAN 1 LEASE GAP COVERAGE 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 Toss" 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 ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan ", 1. 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, 1. 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 depredation 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 Toss. C. SECTION V - DEFINTIONS 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. CA 88 10 01 10 ®2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 5 of 7 15. GLASS REPAIR - WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION 111 - 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. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION 111 - 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. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 17. 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 inception 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. 18. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: 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 are a partnership; 3. Member, if you are a limited liability company; 5 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: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 19. 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 waived those rights before an "accident" or "loss ", our rights are waived also. CA88100110 ©2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 6 of 7 20. 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 damages is 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. SECTION V - DEFINITIONS is amended as follows: 21. BODILY INJURY REDEFINED Under SECTION V - DEFINTIONS, 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. COMMMON POLICY CONDITIONS 22. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. CA 88 10 01 10 02010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc., with Its Permission. Page 7 of 7 COMMERCIAL GENERAL LIABILITY CG 85 83 10 09 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 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 or written agreement. Such person or organization is an additional insured but only with respect to liability for "bodily injury" or "property damage ": 1. Caused by "your work" performed for that additional insured that is the subject of the written contract or written agreement; and 2. Included in the "products- completed operations hazard ". 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. CG 85 83 10 09 02010 Liberty Mutual Insurance Company. All rights reserved. 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 I. Damage To Your Work of Paragraph 2. Exclusions under Section t - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: I. 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. 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 111 - 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. 1 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 Toss 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. 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 z 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. CG 85 83 10 09 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. 02010 Liberty Mutual Insurance Company. Ali rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission . Page 2 of 2 Liberty Northwest. Member or Ubcrty Num! Group Named insured Coverage is Provided In: Ohio Security Insurance Company Common Policy Declarations Agent Policy Number: BLS (14) 55 5119 80 Policy Period: From 07/15/2013 To 07/15/2014 12:01 am Standard Time at Insured Mailing Location IRON CREEK CONSTRUCTION LLC POLICY FORMS AND ENDORSEMENTS (425) 455 -2227 BORDELON INSURANCE This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 12 07 CG 00 68 05 09 CG 01 81 05 08 CG 01 97 12 07 CG 04 42 11 03 CG 04 50 05 08 CG 21 70 01 08 CG 21 76 01 08 CG 21 86 12 04 CG21960305 CG 22 79 07 98 CG 24 26 07 04 CG 26 77 12 04 CG 83 20 12 08 CG 84 94 12 08 CG 84 99 08 09 CG 85 83 10 09 CG 88 10 10 09 CG 88 65 12 08 CG 88 70 12 08 CG 88 77 12 08 CG 89 27 10 09 Commercial General Liability Coverage Form - Occurrence Recording and Distribution of Material or Information in Violation of Law Exclusion Washington Changes Washington Changes - Employment - Related Practices Exclusion Stop Gap - Employers Liability Coverage Endorsement - Washington Washington Changes - Who Is An Insured Cap on Losses From Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion - Exterior Insulation and Finish Systems Silica or Silica- Related Dust Exclusion Exclusion - Contractors - Professional Liability Amendment of Insured Contract Definition Washington - Fungi or Bacteria Exclusion Contractors Amendment of Pollution Exclusion (Job Sites) Exclusion - Consolidated Insurance Programs Wrap -Up Non - Cumulation Liability Limits Same Occurrence Blanket Additional Insured Contractors - Products/Completed Operations Commercial General Liability Extension Voluntary Property Damage Extension Construction Project(s) - General Aggregate Limit (Per Project) Medical Expense At Your Request Endorsement Washington Exclusion - Asbestos In witness whereof, we have caused this policy to be signed by our authorized officers. t -x'16( Dexter Legg Secretary 1 Paul Condrin President To report a claim, call your Agent or 1 -800- 289 -0930 DS 70 21 01 08 07/12/13 55511980 1NWPBOR 235 NCAFPPNO INSURED COPY 001072 PAGE 14 OF 80 COMMERCIAL GENERAL LIABILITY CG 8870/208 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 ail 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 Protect 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 project will 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 70 12 08 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 88 10 10 09 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 13 3 ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON - CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS- EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 5 WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS /MALPRACTICE AND WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES 6 NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 8 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT LIBERALIZATION CLAUSE BODILY INJURY REDEFINED EXTENDED PROPERTY DAMAGE 0 6 7 7 7 7 7 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 7 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU CG 88 10 10 09 ®2010 Liberty Mutual Insurance Company. M rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 1 of 7 N pO_ O 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 t - 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 1- 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 Liabil- ity, 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 thls Coverage Part: 1. Under Paragraph 2. Exclusions of Section 1- 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 follow- s ing: 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: (1) 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. CG 88 10 10 09 4)2010 Liberty Mutual Insurance Company. All rights reserved. includes copyrighted material of Insurance Services Office, inc., with its permission. Page 2 of 7 b. 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. 2. Paragraph 6. under Section 111 - Limits Of Insurance is replaced by the following: 6. 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 sys- tems; 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 (Tenant's 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 1 - 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 AAND 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 11 - 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 part by: 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 "per- sonal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or CG88101009 C12010 Liberty Mutual tnsunance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. 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 ad- vertising 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 ". Insurance applies to premises you own, rent, or control but only with respect to the following hazards: (3) (a) 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 expo- sures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. 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 (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. With respect to Paragraph 1.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. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi- tions. 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section 1- 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 "property damage" occurs. c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying services, including: CG 88 10 10 09 02010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 4 of 7 (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. 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 is- sued by us and made a part of this policy. H. 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 amend- ed 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 addi- tional 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. I. 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. CG 88 10 10 09 ©2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 g 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. 2. 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 Ili - Limits of Insurance of this policy, whichever are Tess. These limits ara 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 II - Who Is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injury': (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 employ- ment 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 health care services. However, if you are not in the business of providing professional health care services or providing profes- sional health care personnel to others, or if coverage for providing professional health care ser- vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. 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 "employ- ees" 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 intoxica- tion by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II - Who Is An Insured is replaced by the following: 3. 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; se 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. CG 88 10 10 09 02010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 P -1 PROPOSAL (unit price) Contractor's Name Z, .ekt. Coax Gels; eviCAloki Contractor's State License No, t c 1J cCc >3 i y O KI City of Tukwila Project No. 91210405 To the Mayor and City Council City of Tukwila, Washington The undersigned (Bidder) hereby certifies that he personally examined the location and construction details of Work outlined in the Contract Documents for the City of Tukwila (Owner) project titled 2013 ADA Improvements, which project includes but is not limited to the removal and reconstruction of approximately 135 square yards of sidewalk and curb ramps at multiple locations within City rights -of -way to meet current ADA standards as well as the conversion of an In-pavement activated pedestrian crosswalk system to a Rapic Flashing Beacon system, including but not limited to s dewaik/asphait demolition, sidewalk & curb ramp construction, curb & gutter construction, traffic control, property restoration and other work necessary to complete the Work as specified and shown in the Contract Documents; and has read and thoroughly understands these Documents which govern all Work embraced in this improvement and the methods by which payment will be made for said Work, and thoroughly understands the nature of said Work; and hereby proposes to undertake and complete all Work embraced in this improvement in accordance with these Contract Documents and at the following schedule of rates and prices: The Bidder understands that the quantities mentioned herein are approximate only and are subject to increase or decrease, and hereby proposes to perform all quantities of work as either increased or decreased in accordance with the Contract Documents. As evidence of good faith, (cheek one) ❑ bid bond or ❑ cash, ❑ cashier's check, ❑ certified check, or 1f1 postal money order made payable to the City of Tukwila equal to five percent (5 %) of the Total Bid Price is attached hereto. Bidder understands that, should this offer be accepted by Owner within ninety (90) calendar days after the day of Bid Opening and the Bidder fails or refuses to enter into an Agreement and furnish the required Payment and Performance Bond and liability insurance within ten (10) calendar days after Notice of Award, the Contract shall be null and void and the Bid Deposit or Bond accompanying this Proposal shall be forfeited and become the property of Owner as liquidated damages, all as provided for in the Bid Documents. Bidder shall attain Physical Completion of ail Work in all respects within Forty -five (45) calendar days from the date stated in the written Notice to Proceed. If the work is not completed within this time period, Bidder shall pay liquidated damages to Owner as specified in Section 1 -08.9 of the Standard Specifications for every calendar day work is not Physically Complete after the expiration of the Contract time stated above. In addition, Bidder shall compensate Owner for actual engineering inspection and supervision costs and any other legal fees incurred by Owner as a result of such delay. 2013 ADA Improvements Rev. 12 -6 -13 Proposal P -2 2013 ADA IMPROVEMENTS - SCHEDULE A Project No. 91210405 Note: Unit prices for all items, all extensions, and the total amount bid must be shown. Where conflict occurs between the unit price and the total amount specified for any item, the unit price shall prevail, and totals shall be corrected to conform thereto. For Schedule A, include applicable Sales Tax in the various Unit and Lump Sum prices. Item No. Item Description Quantity Unit Unit Price Amount SIDEWALK 1. Mobilization 1 LS 14,14-1L-0 . D a 2. Minor Changes EST FA $5,000.00 4,4oc -oo $5,000.00 3. Project Temporary Traffic Control 1 LS 51000. Co �cOo,cC? 4. Temporary Water Pollution /Erosion Control 1 LS 100. oc, 100 . 00 5. Resolution of Utility Convicts Est FA $5,000.00 $5,000.00 6. Pedestrian Traffic Control 1 LS 15(7o.00 7. Removing Asphalt Conc. Pavement 6 SY tc,0- oo (4,00 00 8. Removing Cement Conc. Sidewalk 135 SY 1c • t)o z(-10.0 - oG 9. Removing Cement Conc. Curb & Gutter 45 LF 20- cc) qeo ,co 10. Property Restoration EST FA $4,000.00 $4,000.00 11. Cement Conc. Sidewalk 55 SY 50. Qt;, cep 12. Monolithic Cement Conc. Curb & Sidewalk 32 SY 15 00 '2, , t]C> 13. Reinforced Cement Conc. Curb & Sidewalk 5 SY t'2cr -0o 14. Cement Conc. Curb Ramp Type Perpendicular A 5 EA 2C�c�c�C�.C, 15. Cement Conc. Curb Ramp Type Directional A 1 EA 3,5co CD �;5ZC .cc TRAF €IC. CONTROL. DEVICES 16. Rectangular Rapid Flashing Beacon System Complete 1 LS Ztr i C'c=4,9. 0 c�fJt? . 00 Schedule A Total $ 4 , L4S -CO 2013 ADA Improvements Page 11 Schedule Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale Rev. 12 -6 -13 Proposal P -3 Bids Submitted on Computer Printouts Bidders, at their option, in lieu of hand writing in the unit prices in figures in ink on the Bid forms above, may submit an original computer printout sheet with their bid, as long as the following requirements are met: 1. Each sheet of the computer printout must contain the exact same information as shown on the hard - copy bid form - Project Name, Schedule Name, column headings - in the order shown, totals, etc. 2. The computer •printout of the Bid Proposal must have the exact certification language shown below, signed by the appropriate officer of the firm. 3. If a computer printout is used, the bidder must still execute that portion of the unit price Bid form which acknowledges the Bid Guaranty, Time of Completion, and all addenda that may have been issued, etc. If any of these things are missing or out of order, the bid may be rejected by the Owner. The unit and lump sum prices shown on acceptable printouts will be the unit prices used to tabulate the Bid and used in the Contract if awarded by the City. In the event of conflict between the two, unit Bid prices will prevail over the extended (Total) prices. if the Bid submitted by the bidder contains both the form on these Bid Proposal sheets, and also a computer printout, completed according to the instructions, the unit bid prices shown on the computer printout will be used to determine the bid. Put this certification on the last sheet of the Bid computer printout, and sign: (YOUR FIRM'S NAME) certifies that the unit prices shown on this complete computer print -out for all of the bid items contained in this Proposal are the unit and lump sum prices intended and that its Bid will be tabulated using these unit prices and no other information from this print -out. (YOUR FIRMS NAME) acknowledges and agrees that the total bid amount shown will be read as its total bid and further agrees that the official total Bid amount will be determined by multiplying the unit Bid prices shown in this print -out by the respective estimated quantities shown on the Bid form then totaling all of the extended amounts. Signe - Title: M+�, Date: i \ q 11y 2013 ADA Improvements Rev. 12 -6-13 Proposal P -4 By signing below, Bidder acknowledges receipt and understanding of the following Addenda to the Bid Documents: Addendum No. 1 2 Date of Receipt I 1e\ i4 Addendum No. 3 4 Date of Receipt NOTE: Failure to acknowledge receipt of Addenda may be considered as an irregularity in the Bid Proposal and Owner reserves the right to determine whether the bid will be disqualified. By signing below, Bidder certifies that Bidder has reviewed the insurance provisions of the Bid Documents and will provide the required coverage. It is understood that Owner may accept or reject all bids. The Surety Company which will furnish the required Payment and Performance Bond is vVE 2.1► S4i . I CFW'0A H of 333 s w,oreasrt rG crftc, e , �- roC' Cf (Name) (Address) Bidder: 'sr ,,1 CAL sre.wr loL u-G Signature of Authorized Official. Printed Name and Title: Address: Pert -ti 'Tvzvws"sso 2252 5 SE (c 4 $ p'L b i t fE 222$ c u!}1 - / b. () 'Li Circle One: Individual / Partnership / State of Incorporation: (- Joint Venture / Phone No.: 4z s - ss1- S Z. 1 Date: 119 ty This address and phone number is the one to which all communications regarding this proposal should be sent. NOTES: 1. If the Bidder is a co- partnership, give firm name under which business is transacted; proposal must be executed by a partner. If the Bidder is 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). 2. A bid must be received on all items. If either a unit price or an extension is left blank (but not both) for a bid item, the Owner will multiply or divide the available entry by the quantity, as applicable, and enter it on the bid form. if there is no unit price or extension for one or more bid item(s), the proposal will be rejected. 2013 ADA Improvements Rev. 12 -12 -13 BID SECURrtY 34s Deposit: The underwned Principal hereby dape,sits.a P De wsit with the pity tit °v swig;} the f<snrE of a cash deposit, ('# rti'£ i or ... :xlliet ('h iK br p stai tnOri y order ir} tf"£e amount of . ............ .. .. .. .. ............ .. .. . BOND No. 71497554 S£ sd he. Atoll fee 53 d, : Iron Creek Constuction LLC #;?fE3t 1 k,::: and ::WESTERN SURETY:COMPANI' : are ne :s id £.XXin u'?t0 the : `yt of Tukwity ;�i' Irie >"t t °: 5 tic}, 1E :t t Five Percent of Amount Bid . .. dollars llars C 5% Of Amount Bid • :j v,er }iitj£ t for tjris payment sur ty tiiiid OKeaftClit,, adrnirtiStraiQrS! ryiucv.".7`SOYS t rite: }O riti E rld SV5g0f6ttY.. T t I #% tfi£iy u€ S rf t urger tt£:e Bid Bead ells% be tirotec to t1 . ehe Uzi £ r `t a. �e a ar>unt not ie s.:T.an e ro nt: (5 °. a thy: Ott bid, E 3c €, (1>r? €t tsx sr3d v $0 00410.0.: d' PriEic p # t £ t,t t r £ : e n6Cttori wi €h a Prr. posy #:: . #p}sr.201 :i?tD .ti€£r£r ±te n , :Pr; ct::N£ .:91210405, aeNotdit:4:.ifs tti::ter£rEs. Qt the: Prubcgaf aria t'ir..Ew. lherefo( , : .. .. .. . . f:¢silfs ft:WV.aJ reieried by O dner, o ... ... ... .. s`3, ti the Prtip..ssaf •t`i atOryted and P Pr-fhoipai . wE Mff duly alake 3 3d ent £M '':an grearri with Owner :n nre -Wirt the terme of tile Proposal and :shall: furnish i bond #pi the faithful r £furl ?si re o said Prri3 ct errs fri; the payment of ;eft i rson p rforming lebor or furnishing... • ti' a- ria:s ir° � nnect}ofE 'f3i�r�;st # E. ,513£i�.Sore'ty rsr:S hoot:. appro�rer€ Y Iwacr tkwn - EC £d r� S1#E,aii i 1.F.: Y0ii}SCE it ikY.' : }?:Yr }si3 ECi .:a €€ force and 0 #0- ii.1eit i g €'£aft :faf t the : Pill D sit : or Surety u< ,it ss3t ell }3.at dj' py�:: � r4: fo('� 3 O: OOWrief the::: ::. .. ri:,u>t3f t Th it:P... ,?il.. ::ie -0.-v: nd,fiti:0-.tip (€ i .00)gt e$. : ..: :. •• " h.e Ni ati ni. #.Busty.. at1d €i . t .it f3On ;s!# 1 bs ,: no - ay € r }pairO ar :affe cd by anv oaten o :. . • Owr ei'rnay eer pL r2E Sf FsEi Si..roj. Joe :''eotEU ,t ai j $6 0-1::„ `,tci ii r Yi'i #siti'r£ :tf? 9th :::Iron:Creek Construction; LIE: ... . January : :2-014 WESTERN:SURETY COMPANY:: :: i i2t f0E• 0 01f3rr E::: arnt .in Fact (2 .,aat Power f:A wrnsy) .. ............ .. .. .. ............ .. PAUL D BORDELON .: • .:. . • . ... ... •`{ it@. Nc3f n{k and f i; €iiteS• "s i t3 .tC1 'i i; Of f ic0 �3l a ;£'st::aric fit:5£o.e.f :.: {io E edty.>: :. WESTERN SURETY COMPANY 333 S. Wabash Av :e.:41st Floor ::: Chicago, IL 60604: !i? fii :t[:al i t?zS' O th i:W?6?E ?z A sttho zedi{'itzji.t }�:;e: l:f�f,;it;: •9 '�3i$':_ti1 !7L:Z3fF 1 e}i r or !f?a: STATE OF COUNTY OF Washington King SS ACKNOWLEDGMENT OF SURETY (Attorney -in -Fact) Bond No. 71497554 On this day of � i a P / , before me, a notary public in and for said County, personally appeared / PAUL D BORDELON to me personally known and being by me duly sworn, did say, t t he /she is the Attorney -in -Fact of WESTERN SURETY COMPANY, a corporation of Sioux Falls, South Dakota, created, organized and existing under and by virtue of the laws of the State of South Dakota, that the said instrument was executed on behalf of the said corporation by authority of its Board of Directors and that the said PAUL D BORDELON acknowledges said instrument to be the free act and deed of said corporation and that he /she has authority to sign said instrument without affixing the corporate seal of said corporation. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal at Bellevue Washington My commissio ex ires Form 106 -9 -2013 LIIJJI _•_. _ 1Z l Notary :017 is last above written. Western Surety Company POWER OF ATTORNEY - CERTIFIED COPY Bond No. 71497554 Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company "), does by these presents make, constitute and appoint PAUL D BORDELON its true and lawful attorney(s) -in -fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its behalf as Surety, bonds for: Principal: Iron Creek Construction, LLC Obligee: City of Tukwila Amount: $500,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s) -in -fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." All authority hereby conferred shall expire and terminate, without notice, unless used before midnight of 2 014 , but until such time shall be irrevocable and in full force and effect. April 9 In Witness Whereof, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its corporate se„ t - affixed this 9th day of January , 2014 ST . . 40U"_, .1j:W53Th A ss COUN1��" :�'�1 =IAHA / / 1111 WEST.' R►. SURE COMPANY Paul T. ruflat, Vice President On this 9th day of January , in the year 2014 , before me, a notary public, personally appeared Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act and dee f said coo at' on. %%%%% Yw<sa.d.%%%%%%4444:4 + S. PETRIK • NOTARY PUBLIC + • i SOUTH DAKOTA SEAL My Commission Expires August 11, 2016 I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. - In testimony whereof, I have hereunto set my hand and seal of Western Surety Company this otary Public - South Dakota January , 2014 Form F5306 -8-2012 WEST 9th day of SURETY COMPANY Paul T. uflat, Vice President R-6 NON- COLLUSION DECLARATION STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) The undersigned, being first duly sworn, on oath states that the person, firm, association, partnership, joint venture, or corporation named in the Bid Proposal 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 City of Tukwila project named 2013 ADA Improvements, Project No. 91210405. Signed and sworn to before me on this q ncN C NsTt2.k-t CX1 e&i Name of Firm ature of Authorized Official Title day of a' , 20 1 . Signature of Notary Public in and for the State of Washington, residing at M V44,1 f=y , vliM- My appointment expires: 513 \ 2-ct SEAL To report bid rigging activities call: NOTICE TO ALL BIDDERS 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. 2013 ADA improvements Rev. 12 -6-13 P -7 RESPONSIBLE BIDDER DETERMINATION FORM Attach additional sheets as necessary to fully provide the information required. Name of Bidder: ►,1 C2-\L CCNssru.tic.xio (AC- Address of Bidder: 2.2525 ‘-1 r-r✓ 22-23 w 602:7 City State Zip Code Contractor's License No. I etOtec t-iikA J WA State UBI No. Cp3 2.b(.., 11 1 Dept. of L &I License Bond Registration No. `t l's; g c3 vn LI Workers Comp. Acct. No. .i14- Bidder is a(n): ❑ Individual ❑ Partnership ❑ Joint Venture 14, incorporated in the state of List business names used by Bidder during the past 10 years if different than above: RAc1m: s.(o2ThwesX EArr-- `nA,vcfzic.5 Bidder has been in business continuously from Bank Reference &hi n; -. 3Ar l \t. Bank 'ZOO(,) Year P v (.701-kr . Account Officer Officer's Phone No. No. of regular full -time employees: Number of projects in the past 10 years completed: le ahead of schedule 12- on schedule © behind schedule Bidder has had experience in work comparable to that required for this Project: As a prime contractor for 1 years. As a subcontractor for 1 years. List the supervisory personnel to be employed by the Bidder and available for work on this project (Project Manager, Principal Foreman. Superintendents, and Engineers): Name Title How Long With Bidder PAL 'TT-v Flop' -lri c1�ErJ C- -T 6-1.4 �1�ti�►.i Douro tS Paosccr tAM x- 2013 ADA improvements Rev. 12 -6-13 Responsible Bidder Determination Form P -8 Name the Surveyor to be used on this Project, who will directly supervise all surveying activities. Attach a resume outlining the experience and qualifications of the Surveyor. Is the Surveyor licensed in the State of Washington (a PLS)? '4 Yes ❑ No Surveyor's Name: cpt List all those projects, of similar nature and size, completed by Bidder within the past 10 years. Include a reference for each. Any attached preprinted project listing must include all this information. Bidder must have at least 10 years experience working on projects of similar nature and size. Year Contract Proiect Name Completed Amount 2 M k-3c Doti -wme.. 2D i 3 4 41 v C i'vN=' ' $.42*— -Lc .0> Yt ZS it Sf 1.9 Sr z c� 131 Z6 x_ t9SH4 si Sa 7Fa. 20 1� 2� ►c_ we r 41 ia3 `aE 51,74- Sr Z.c 12 44 )01 14_ OwnerfReference Name and Phone wet�lrJ��ctt= - i-' l✓1111t=2-- - 817 - 2zR6 bv-i - (1-1C.Ie w+-t &( 4 2 - 123 ) ►Jec%T'E- Kc W Sv1ilhi%i -L I -coyyV S ;,3 SN 6 Sr,u:t:.1t - .53SE e v- Zo& ` 7-Hc/ f3 7c css4; 941 -TCuv �IN,WF.ni L t'••-37- ?../ , gr-TMN %E - CI►✓Ir NclsekJ 'i.25 -4S7_ — List all projects undertaken in the last 10 years which have resulted in partial or final settlement of the Contract by arbitration or litigation in the courts: Name of Client and Project Contract Amount g A- Total Claims Arbitrated or Litigated. 414— Amount of Settlement of Claims IA- Has Bidder, or any representative or partner thereof, ever failed to complete a contract? j2i.No ❑ Yes If yes, give details: Has Bidder ever had any Payment/Performance Bonds called as a result of its work? ;el No ❑ Yes If yes, please state: Project Name 2013 ADA Improvements Contracting Party Bond Amount Rev. 12 -6 -13 Responsible Bidder Determination Form P -9 Has Bidder ever been found guilty of violating any State or Federal employment laws? j5i(No Q Yes If yes, give details: 1.1 1,4 Has Bidder ever filed for protection under any provision of the federal tRankruptcy laws or state ins6iveeey laws? )No Q Yes if yes, give details: ;,� i'{r Has any adverse legal judgment been rendered against Bidder in the past 5 years? ,%No 0 Yes If yes, give details: rJ Has Bidder or any of its employees filed any claims with Washington State Workman's Compensation or other insurance company for accidents resulting in fatal injury or dismemberment in the past 5 years? *No 0 Yes If yes, please state: Date Type of Injury Agency Receiving Claim 141k er alr� The undersigned warrants under penalty of Perjury that the foregoing information is true and accurate to the best of hislher knowledge. The undersigned authorizes the City of Tukwila to verify all information contained herein. Signature of Bidder Title: M 2013 ADA Improvements Date: i \q \v-i Rev. 12 -6-13 P -10 PROPOSED EQUIPMENT AND LABOR SCHEDULE (Use additional sheets if required) Equipment to be used: DESCRIPTIONITYPE YEAR CONDITION OWN/RENT c I s E cx 'etc Ex. e_ikv = - o ri 2coLf Grz-F}-7- ouo Q 'LI: on Alst,t cri t) Excfl -,� cL- 199'6 Ge,o0 ©a) ki o4—T— 9 ( t) A-2 leil b c�a-F -A-r- CLC of KW L— DLt on P Tv:AA o _, VIVO C- \-- ou) t.1 Fat-i F -LSD 2co -1 6-‘c&-ii r'yJ , 00-44 Labor to be used: C- ,iC n -C L4 %c QSL, u evi,t_vnt- &P32 , rrtLtca.c -- bvu A--- t.1 L C_entcMaccicnt u C Name of Bidder t- - nature of Authorized Official Tide 2013 ADA Improvements Rev, 12-6-13 P -11 PROPOSED SUBCONTRACTORS Name of Bidder u max., cxkst 11J10I J LI-C.- In accordance with RCW 39.30.060 as amended, every bid that totals $1 million or more shall include below the names of the subcontractors with whom the Bidder, if awarded the contract, will subcontract for performance of the work of: HVAC (heating, ventilation, and air conditioning); plumbing as described in chapter 18.106 RCW; and electrical as described in chapter 19.28 RCW, or to name itself for the work. The Bidder shall not list more than one subcontractor for each category of work identified, unless subcontractors vary with bid alternates, in which case the Bidder must indicate which subcontractor will be used for which alternate. Failure of the Bidder to submit as part of the bid the names of such subcontractors or to name itself to perform such work or the naming of two or more subcontractors to perform the same work shall render the prime contract bidder's bid nonresponsive and, therefore, void. The successful Bidder must have the written permission of the Owner to make any change to this list. Percent of total bid to be performed by Bidder °lo Schedule /Bid Item Numbers % of Name Subcontractor will perform Total Bid 2013 ADA Improvements 14 Ig- NIA- Rev. 12 -6-13 QUOTE TO: ATTN: PHONE: FAX: (eIaMe Canc te LLC GENERAL COIYTRA (TORS CONCRETE Subquote JOB NAME: 2013 ADA IMPROVEMENTS CITY OF TUKWILA BID DATE: 01/09/2014 IT NO. TEM DES( TIPT ON UNIT QTY X UNIT PRICE DOLLARS (T' AMOUNT DOLLARS-CTS MOBILIZATION LS X 3,000.00 3,000.00 11 CEMENT CONC SIDEWALK S Y 55 X 40.00 2,200 00 12 MONOLITHIC OMNI CONC CURB & SIDEWALK 32 X 60.00 1,920.00 13 REINFORCED CEMENT CONC CURB & SIDEWALK SY X 100.00 500.00 14 CEMENT CONC CURB RAMP TYPE PERPENDICULAR A EA X 2,500.00 12,500.00 15 CliMENT CONC CURB RAMP TYPE DIRECTIONAL A EA 2,000.00 213)0.00 BID TOTAL $22,120.00 NOTES: [X] INCLUDES PREVAILING WAGES (KING (01 \ 11 --ST,#TE J 16ES 41)PL1) [X] INCLLIDES NO ADDENDUMS X] BID IS FOR FOR.MING AND POURING OF CONCRETE FOR nEm WS ABOVE ONLY X] GENERAL CON 'TRACTOR To PROVIDE ALL TI:ZAITIC CONTROL. X] BONDS, PERMITS AND FEES NOT INC 0111)1 X] AGGREGATE BASE MATERIAL AND PREP 13Y oTHERS. X] QUOTE IS GOOD FOR 30 DAYS FROM DATE, OF PROPOSAL X] PAYMENT TERMS ARE NET 30 DAYS. PAST DUE ACCOUNT WILL BE ASSESSED INTEREST AT THE :RATE 0 1 1 .5% PER MONTH AND ,REASONABLE COLLECTION COSTS WILT, BE ADDED. [X] THIS PROPOSAL WILL BE AN ATTACHMENT TO ANY CONTRACT ISSLED. [X] SALES TAX NoT INCLUDED. PROPOSAL ACCEPTANCE: X BY: DATE: Contact: Rebekah Williams (971) 998-9334 or KELAYECONCRETE(a)comcastnet TEL: (971) 998-9334 FAX: (503) 855-3533 Email: KELAYECONCRETEca,comcast.net WA Contractor License 4: KELAYECL876K2 10742 SE Hwy 212 Clackamas, OR 97015 PO Box 1003 Boring, OR 97009 CITY OF TUKWILA 2013 ADA Improvements ADDENDUM NUMBER 1 DATE OF ADDENDUM ISSUE: January 8, 2014 DATE OF RFP DUE: January 9, 2014 NOTE TO ALL PLANHOLDERS: This Addendum Number 1, containing the following revisions, additions, deletions, and /or clarifications, is hereby made a part of the PIans and Contract Provisions (Contract Documents) for the above -named project. Bidders shall take this Addendum into consideration when preparing and submitting their bids. Bidders shall acknowledge receipt and acceptance of this Addendum Number 1 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledge may result in disqualification of the Bidder's submittal. CONTRACT PROVISIONS Section 8 -20 Illumination, Traffic Signal Systems, and Electrical (SP -54 and SP -55) Revise the following: 8 -20.1 Description Line 20: "... installing - solar powered rectangular ... " 8 -20.2 Materials. Line 37: "... connected to solar power_ 8 -20.3 Construction Requirements ADD: "Signs shall be fluorescent yellow and black (36 "x 36 "). Addendum No. 1 January 8, 2014 Page 1 of 2 Page 1 Addendum #1 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale ALL OTHER REQUIREMENTS OF THE CONTRACT DOCUEMENTS REMAIN IN EFFECT. Bidders shall acknowledge receipt and acceptance of this Addendum No. 1 in the space provided on the Proposal Signature Sheet or by signing in the space provided below and submitting the signed addendum with the bid package. Failure to provide this written acknowledgement may result in disqualification of the Bidder's submittal. Sincerely, Robin. Tischmak, P.E. City Engineer City of Tukwila Receipt acknowledged and conditions agreed to this cj Jf day or a 4 , 2014. Page 2 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see wvvw.bxwa.com - Always Verify Scale