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HomeMy WebLinkAbout20-111 - Michels Corporation - 2020 Central Business District (CBD) Sanitary Sewer Rehabilitation20-111 Council Approval 10/5/20 AGREEMENT FORM CONTRACT NO. 91/'4E:3203 � THIS AQREEK4ENT�made and an��d�� {^��- day of 08 -do ee- , 2OZO.byand between the City ofTukwila, Washington cY]wner") and tioitxtilL("Contractor"), Now. Nere�rethe panbeuagree asfbUovm: ' 1. Project. Contractor shall complete all work and furnish all labor, tools, mahsdo|o, and equipment for the project entitled 2020 CENTRAL BUSINESS DISTRICT SANITARY SEWER REHA0TAT0N - PHASE 4, Project No. 31140203' 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. er 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 ofpayment. 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 VVork under thin Agreement is not conipleted within the time specilied, as detailed in the Contract, Documents, Contraclor 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 attorneys 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' -h which shall fcir ari purposes be deemed an. ariginal. CITY OF K��ne(Owner)| [,_. 4mvxw,„65o4g By:� Mayor 10/28/2020 Attest: 28th day of October , 20 20 CityClerk Approved aataForm: �Attorney C� Addressfor A 2020Central Business District Sanitary Sewer Rehabilitation ' Phase 4 Vit CAW -1.S Co v-iflo tiva.T1 (Con<nsc�r) By: Title: Uae './..o.w'- 4��y_~_ This 19 day of L~e3� .. 2020 )N,s1.3 sec. Contractor's License No. vikr-KG.QAt. 10,9 31 Address for giving notices: (-?CS- \/44~ Z� Rev. 5-13-14 C-2 PAYMENT AND PERFORMANCE BOND Bond to City of Tukwila, Washington Bond No. 30110958/190046322 Continental Casualty Company & We, Michels Corporation , and Liberty Mutual Insurance Company (Principal) (Surety) a IL & MA corporation, and as a surety corporation authorized to become a surety upon Bonds of Contractors with municipal corporations in Washington State, are jointly and severally bound to the City of Tukwila, Washington ("Owner"), in the penal sum of Seven Hundred Nine Thousand Nine Hundred Seven and 00/100 Dollars ($709,907.00 ), the payment of which sum, on demand, we bind ourselves and our successors, heirs, administrators, executors, or personal representatives, as the case may be. This Payment and Performance Bond is provided to secure the performance of Principal in connection with a contract dated October 14 , 2020 , between Principal and Owner for a project entitled 2020 CENTRAL BUSINESS DISTRICT SANITARY SEWER REHABILITATION — PHASE 4, Contract No. 91140203 ("Contract"). The initial penal sum shall equal 100% of the Total Bid Price, including sales tax, as specified in the Proposal submitted by Principal. NOW, THEREFORE, this Payment and Performance Bond shall be satisfied and released only upon the condition that Principal: • Faithfully performs all provisions of the Contract and changes authorized by Owner in the manner and within the time specified as may be extended under the Contract; • Pays all laborers, mechanics, subcontractors, lower tier subcontractors, material men, and all other persons or agents who supply labor, equipment, or materials to the Project; • Indemnifies and holds Owner, its officers, and agents harmless from and against all claims, liabilities, causes of action, damages, and costs for such payments for labor, equipment, and materials by satisfying all claims and demands incurred under the Contract, and reimbursing and paying Owner all expenses that Owner may incur in making good any default by Principal; and • Indemnifies and holds Owner harmless from all claims, liabilities, causes of action, damages, and costs, including property damages and personal injuries, resulting from any defect appearing or developing in the material provided or workmanship performed under the Contract. The indemnities to Owner shall also inure to the benefit of the Consulting Engineers and other design professionals retained by Owner in connection with the Project. This bond shall remain in effect for one (1) year after Final Acceptance of the Contract at ten percent (10%) of the Total Bid Price, including sales tax, to insure against all defects and corrections needed in the material provided or workmanship performed. The liability of Surety shall be limited to the penal sum of this Payment and Performance Bond. No change, extension of time, alteration, or addition to the terms of the Contract or to the Work to be performed under the Contract shall in any way affect Surety's obligation on the Payment and Performance Bond. Surety hereby waives notice of any change, extension of time, alteration, or addition to the terms of the Contract or the Work, with the exception that Surety shall be notified if the Contract time is extended by more than twenty percent (20%). If any modification or change increases the total amount to be paid under the Contract, Surety's obligation under this Payment and Performance Bond shall automatically increase in a like amount. 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Payment and Performance Bond C-3 Any such increase shall not exceed twenty-five percent (25%) of the original amount of the Payment and Performance Bond without the prior written consent of Surety. This Payment and Performance Bond shall be governed and construed by the laws of the State of Washington, and venue shall be in King County, Washington. IN WITNESS WHEREOF, the parties have executed this instrument in two (2) identical counterparts this 14th day of October I 2020. Name and address of local office of agent and/or Surety Company: Continental Casualty Company & Liberty Mutual Insurance Company Surety N/A S'inature of Authored Official B Heather R. Goedtel Attomey in act (Attach Power of Attorney) Willis Towers Watson Midwest, Inc. 8400 Normandale Lake Blvd., Suite 1700 Bloomington, MN 55437 Surety companies executing bonds must appear on the current Authorized Insurance List in the State of Washington per Section 1-02.7 of the Standard Specifications. 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Surety Acknowledgment State of Minnesota } } ss. } County of Hennepin On this 27th day of August 2020, before me personally came Heather R. Goedtel, to me known, who being by me duly sworn, did depose and say that she is the Attorney -in -Fact of Continental Casualty Company described in and which executed the above instrument; that she/he knows the seal of said corporation; that the seal affixed to said instruments is such corporate seal, that it was so affixed by order of the Board of Directors of said corporation, and that she/he signed her/she/his name to it by like order. OLE CATHERINE LANGER Notary Public Minnesota My Commission Expires Jan 31, 2023 ww- .gym- - - r 4153. POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Laurie Pflug, Brian D. Carpenter, Jessica Hoff, Nicole Langer, Craig Olmstead, Trisha Kasper, Blake S. Bohlig, Heather R. Goedtel, Kelly Nicole Enghauser, Michelle Halter, Individually of Bloomington, MN, their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited. Amounts - and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by thcir Vice President and their corporate seals to be hereto affixed on this 2nd day of December, 2019. Continental Casualty Company National Fire Insurance Company of Hartford American Casualty Company of Reading, Pennsylvania Paul T. Bruflat Vice President State of South Dakota, County of Minnehaha, ss: On this 2nd day of December, 2019, before me personally carne Paul T. Bruflat to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vicc President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. J. MOHR ricuRyFuzucCZ SOUTH DAROTA My Commission Expires June 23, 2021 J. Mohr Notary Public CERTIFICATE I, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 27th day of August , 2020 Form F6853-4/2012 Continental Casualty Company National Fire Insurance Company of Hartford American Casualty Company of Reading, Pennsylvania D. Johnson Assistant Secretary Go to www.cnasuretv.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. ui 0 0 _c0 �m a)c, rn U 0 O a) > --0 c.5 O L. 0 0 c CY)0) co m N o,c ai 0 > O ‘5 This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Blake S. Bohlig, Brian D. Carpenter, Kelly Nicole Enghauser, Heather R. Goedtel, Michelle Halter, Jessica Hoff, Nicole Langer, Craig Olmstead, Laurie Pflug Certificate No: 8202635-190003 all of the city of Bloomington state of Minnesota each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21st day of November , 2019 . Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company By: i.. . David M. Carey, Assistant Secretary State of PENNSYLVANIA ss County of MONTGOMERY On this 21st day of November , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. Pas OF A Q. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Teresa Pastella, Notary Public Upper MerionTwp., Montgomery County My Commission Expires March 28, 2021 Member, Pennsylvania Association of Notaries By: Lta,„ eresa PasNlla. Notary Public eresa Pastella, Public This Power of Attomey is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV—OFFICERS: Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attomey issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attomey of which the foregoing is a full, true and correct copy of the Power of Attomey executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 14th day of October , 2020 . LMS -12873 LMIC OCIC WAIC Multi Co 062018 By: Renee C. Llewellyn, Assistant Secretary > m -o0) 0) c .0) -o c k0 c 0 _I— cO) W >E 0- '-0 M Q d' 0 = N f0 O 0- O 10) 00 73* > 0 "4- .0 N 00 r- 4-= M c CO 00 0 c9 1 r Page 1 of 2 s 1 r+� AC R130 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YWY) 10/13/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Towers Watson Midwest, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT Willis Towers Watson Certificate Center NAME: 18/C No No Ext): 1-877-945-7378 FAX No): 1-888-467-2378 E-MAIL ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC 9 INSURERA: Greenwich Insurance Company 22322 INSURED Michels Corporation 1715 16th St SE Salem, OR 97302INSURERD: INSURER B: XL Insurance America Inc 24554 INSURER C: XL Specialty Insurance Company 37885 AIG Specialty Insurance Company 26883 INSURERS: Indian Harbor Insurance Company 36940 INSURER F : COVERAGES CERTIFICATE NUMBER: W18256959 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y CGD740955303 02/01/2020 02/01/2021 EACH OCCURRENCE S 3,000,000 DAMAGE RENTED PREM SESO(Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY S 3,000,000 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PES PER: LOC PRODUCTS - COMP/OPAGG S 6,000,000 S A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY Y CAD740955403 02/01/2020 02/01/2021 COMBINED SINGLE LIMIT (Ea accident) $ 5,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ B X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE Y US00077661L120A 02/01/2020 02/01/2021 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10,000,000 $ DED RETENTIONS C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N No NIA CWD740955103 02/01/2020 02/01/2021 X I PER STATUTE OTH- ER E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Workers Compensation - WI and Employers Liability Work Comp: Per Statute CWR740955203 02/01/2020 02/01/2021 E.L. Each Accident E.L. Disease -Each EmF E.L. Disease-Pol Lmt $1,000,000 $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Tukwila Project No: 91190203 SEE ATTACHED CERTIFICATE HOLDER CANCELLATION City of Tukwila 6200 Southcenter Blvd, 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20208734 BATCH: 1849007 ACORE' AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Willis Towers Watson Midwest, Inc. NAMED INSURED Michels Corporation 1715 16th St SE Salem, OR 97302 POLICY NUMBER See Page 1 CARRIER See Page 1 NAIC CODE See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Re:. 200623-2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 - Tukwila, WA RH2 Engineering, Inc, the Contracting Agency and its officers, elected officials, employees, agents, and volunteers re Additional Insureds with respect to the General Liability, Auto Liability, Contractor's Pollution Liability and Umbrella/Excess Liability coverage and the work performed by the Named Insured when required by written contract, agreement or permit executed prior to loss. Such insurance as is afforded to Additional Insured shall be Primary and Non-contributory with any other insurance available to Additional Insured if required by contract executed prior to loss. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability policy. INSURER AFFORDING COVERAGE: AIG Specialty Insurance Company NAIC#: 26883 POLICY NUMBER: CPO 8197229 EFF DATE: 02/01/2019 EXP DATE: 02/01/2021 ADDITIONAL INSURED: Y TYPE OF INSURANCE: Contractors Pollution LIMIT DESCRIPTION: LIMIT AMOUNT: Each Loss $5,000,000 Aggregate $5,000,000 INSURER AFFORDING COVERAGE: Indian Harbor Insurance Company NAIC#: 36940 POLICY NUMBER: CE0744659503 EFF DATE: 02/01/2020 EXP DATE: 02/01/2021 TYPE OF INSURANCE: Professional Liability LIMIT DESCRIPTION: EA Claim Aggregate Limit EA Claim Deductible LIMIT AMOUNT: $1,000,000 $1,000,000 $100,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20208734 BATCH: 1849007 CERT: W18256959 ENDORSEMENT # This endorsement, effective 12:01 a.m., 02/01/2020, forms a part of Policy No. CGD740955303 issued to M10, INC. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: Any person or organization with whom you have agreed, through written contract, agreement or permit, executed prior to loss, provide additional insured coverage and where that contract demand specifies ISO 2001 edition forms. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: XIL 2010-1001 (Ed. 0413) © 2013, XL America, Inc. Page 1 of 2 All rights reserved. May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission 2. Exclusions This insurance does not apply to "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 site 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. All other terms and conditions remain unchanged. XIL 2010-1001 (Ed. 0413) © 2013, XL America, Inc. Page 2 of 2 All rights reserved. May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission ENDORSEMENT # This endorsement, effective 12:01 a.m., 02/01/2020, forms a part of Policy No. CGD740955303 issued to M10, INC. by Greenwich Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: Any person or organization with whom you have agreed, through written contract, agreement or permit, executed prior to loss, provide additional insured coverage and where that contract demand specifies ISO 2001 edition forms. Location And Description of Completed Operations: Various as required per written contract. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and XIL 2037-1001 (Ed. 0413) © 2013, XL America, Inc. Page 1 of 2 All rights reserved. May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission described in the schedule of this endorsement performed for that insured and included in the "products - completed operations hazard". All other terms and conditions remain unchanged. XIL 2037-1001 (Ed. 0413) © 2013, XL America, Inc. Page 2 of 2 All rights reserved. May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: CGD740955303 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ALL PROJECTS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project 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 Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense 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 Designated Construction Project General Aggregate Limit. © Insurance Services Office, Inc., 2008 Page 1 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section 1 — Coverage A, and for all medical expenses caused by accidents under Section 1 — Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 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 Designated Construction Project General Aggregate Limit. CG 25 03 05 09 C. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "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 Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, de -signs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section 111 — Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. © Insurance Services Office, Inc., 2008 Page 2 POLICY NUMBER: CAD740955403 XIC 411 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM A. COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured, is amended to include as an "insured" any person or organization you are required in a written contract to name as an additional insured, but only for "bodily injury" or "property damage" otherwise covered under this policy caused, in whole or in part, by the negligent acts or omissions of: 1. You, while using a covered "auto"; or 2. Any other person, except the additional insured or any employee or agent of the additional insured, operating a covered "auto" with your permission; Provided that: a. The written contract is in effect during the policy period of this policy; b. The written contract was signed by you and executed prior to the "accident" causing "bodily injury" or "property damage" for which liability coverage is sought; and c. Such person or organization is an "insured" solely to the extent required by the contract, but in no event if such person or organization is solely negligent. B. The Limits of Insurance provided for the Additional Insured shall not be greater than those required by contract and, in no event shall the Limits of Insurance set forth in this policy be increased by the contract. C. General Conditions, Other Insurance is amended asfollows: Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary, excess, contingent or on any other basis unless the contract specifically requires that this policy be primary. All terms, conditions, exclusions and limitations of this policy shall apply to the liability coverage provided to any additional insured, and in no event shall such coverage be enlarged or expanded by reason of the contract. All other terms and conditions of this policy remain unchanged. XIC 411 1013 © 2013 X.L. America, Inc. All Rights Reserved. May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 P-1 PROPOSAL (unit price) 11 Contractor's Name WLtrt�tSCNicact,TIc Contractor's State License No. ►tq..CIkGC irii T -g City of Tukwila Project No. 91140203 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 2020 CENTRAL BUSINESS DISTRICT SANITARY SEWER REHABILITATION — PHASE 4, which project includes but is not limited to: Installation of approximately 5,950 linear feet (LF) of cured -in-place pipe (CIPP) within the right-of-way of Andover Park West and Strander Boulevard to rehabilitate existing sewer main and other work necessary to complete the Work as specified and shown in the Contract Documents. The Bidder 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, (check one)'bid bond or ❑ cash, ❑ cashier's check, 0 certified check, or 0 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 all Work in all respects within one hundred eighty (180) working days from the date stated in the written Notice to Proceed and within sixty (60) working days once the Contractor has mobilized their cured -in-place lining equipment to the site. 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. 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Proposal P-2 2020 CENTRAL BUSINESS DISTRICT SANITARY SEWER REHABILITATION - PHASE 4 (CIPP lining on Andover Park West and Strander Boulevard) Project No. 91140203 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 sha I prevail, and totals shall be corrected to conform thereto. Item No. Item Description Quantity Unit Unit Price Amount 1. Mobilization 1 LS $ 35,524.00 $ 35,524.00 2. Traffic Control - Flagger Labor (Minimum Bid of $43.11) 216 HOUR $ 76.75 $ 16,578.00 3. Traffic Control -Off-duty Uniformed Police Officer 108 HOUR $110.00 $11,880.00 4. Project Temporary Traffic Control 1 LS $ 68,174.00 $ 68,174.00 5. Pre -cleaning Video Inspection 1 LS $ 16,614.00 $ 16,614.00 6. Clean and Prep Sewer Prior to Construction 1 LS $ 20,243.00 $ 20,243.00 7. Video Inspection Prior to Construction 1 LS $ 8,307.00 $ 8,307.00 8. Provide, Install, and Manage Wastewater Bypasses 1 LS $ 78,542.00 $ 78,542.00 9. 8 -inch Main Line CIPP 1,833 LF $ 37.00 $ 67,821.00 10. 12 -inch Main Line CIPP 1,554 LF $ 49.00 $ 76,146.00 11. 21 -inch Main Line CIPP 2,160 LF $ 83.00 $ 179,280.00 12. 24 -inch Main Line CIPP 400 LF $ 120.00 $ 48,000.00 13. 8 -inch Main Line CIPP Pre -liner (If CIPP Liner is Steam Cured) 180 LF $ 2.00 $ 360.00 14. 12 -inch Main Line CIPP Pre -liner (If CIPP Liner is Steam Cured) 160 LF $ 2.50 $ 400.00 15. 21 -inch Main Line CIPP Pre -liner (If CIPP Liner is Steam Cured) 220 LF $ 3.75 $ 825.00 16. 24 -inch Main Line CIPP Pre -liner (If CIPP Liner is Steam Cured) 40 LF $ 4.25 $ 170.00 17. Trenchless Lateral Reinstatement and Packer Injection Grouting 3 EA $ 1,286.00 $ 3,858.00 18. Trenchless Outside Manhole Drop Connection Reinstatement 1 EA $ 648.00 $ 648.00 19. Force Account - Minor Changes 1 LS $12,000.00 $12,000.00 Subtotal 10.0% Sales Tax Total Bid (Subtotal w/WSST) 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 645,370.00 $ 64,537.00 $ 709,907.00 Rev. 5-13-14 ?rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal 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 at 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 FIRM'S 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. Signed: Title: Date: By signing below, Bidder acknowledges receipt and understanding of the following Addenda to the Bid Documents: Addendum No. 1 2 Date of Receipt 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. 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 ?rovided to Builders Exchange of 'qA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Proposal P-4 The Surety Company which will furnish the required Payment and Performance Bond is CnitTtACIA.1 C of C_. (Name) (Address)` Bidder: tndteh S £O 7.1 :, :�- f` ,. '�•' Signature of Authorized Official: Printed Name and Title: Address: ..... Scot+ lea' LU�PS�'cQ�-4211tMu-X �5' f l tS kilt 'Sr SE $M973°4-2 Circle One: Individual / Partnership / Joint Venture Corporation Phone No.: ct�3 -30-1(9 9 State of Incorporation: Gt.)i Date: 0 ia'7 / Z d Z o This address and phone number is the one to which all communications regarding this proposal should be sent. NOTES: 1. If the Bidder is a co -partnership, give firm name under which business is transacted; proposal must be executed by a partner. If the Bidder is a corporation, proposal must be executed in the corporate name by the president or vice-president (or any other corporate officer accompanied by evidence of authority to sign). 2. A bid must be received on all items. If either a unit price or an extension is left blank (but not both) for a bid item, the Owner will multiply or divide the available entry by the quantity, as applicable, and enter it on the bid form. If there is no unit price or extension for one or more bid item(s), the proposal will be rejected. 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-5 BID SECURITY Bid Deposit: The undersigned Principal hereby deposits a Bid Deposit with the City of Tukwila in the form of a cash deposit, certified or cashier's check, or postal money order in the amount of dollars ($ ). -- OR -- Bid Bond: The undersigned, Michels Corporation (Principal), and Continental Casualty Company (Surety), are held and firmly bound unto the City of Tukwila (Owner) in the penal sum of Five Percent of Amount Bid dollars ($ 5% ), which for the payment of which Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. The liability of Surety under this Bid Bond shall he limited to the penal sum of this Bicl Bond. Conditions: The Bid Deposit or Bid Bond shall he an amount not Tess than five percent (5%) of the total bid, including sales tax and is submitted by Principal to Owner in connection with a Proposal for 2020 CENTRAL BUSINESS DISTRICT SANITARY SEWER REHABILITATION — PHASE 4, Project No. 91140203, according to the terms of the Proposal and Bid Documents. Now therefore, a. If the Proposal is rejected by Owner, or b. If the Proposal is accepted and Principal shall duly make and enter into an Agreement with Owner in accordance with the terms of the Proposal and shall furnish a bond for the faithful performance of said Project and for the payment of all persons performing labor or furnishing materials in connection therewith, with Surety or Sureties approved by Owner, then this Bid Security shall be released; otherwise it shall remain in full force and effect and Principal shall forfeit the Bid Deposit or Surety shall immediately pay and forfeit to Owner the amount of the Bid Bond, as penalty and liquidated damages. The obligations of Surety and its Bid Bond shall he in no way impaired or affected by any extension of time within which Owner may accept bids; and Surety does hereby waive notice of any such extension. ‘`v-1 "" Srgt)ed and dated this 27th t r 0 . ,, i. U,ry1,rch0.Qorporation Principal day of August , 2020 - ). �Stgr�tt of Authorized Official rt I_u tat u..0 Title / Name and address of local office of Willis Towers Watson Midwest, Inc. Continental Casualty Company Surety ttorney in Fact (ttach Power of Attorney) Heather R. Goedtel agent and/or Surety Company: 8400 Normandale Lake Blvd., Suite 1700 Bloomington, MN 55437 Surety companies executing bonds must appear on the current Authorized Insurance List in the State of Washington per Section 1-02.7 of the Standard Specifications. 2020 Central Business District Sanitary Sevier Rehabilitation - Phase 4 Rev. 5-13-14 Provided to Euilciers Exchange of WA, _Inc. For usage Conditions Agreement see w•ww.bx•::a.corn - Always Verify Scal Surety Acknowledgment State of Minnesota } } ss. County of Hennepin } On this 14th day of October 2020, before me personally came Heather R. Goedtel, to me known, who being by me duly sworn, did depose and say that she is the Attorney -in -Fact of Continental Casualty Company & Liberty Mutual Insurance Company described in and which executed the above instrument; that she/he knows the seal of said corporation; that the seal affixed to said instruments is such corporate seal, that it was so affixed by order of the Board of Directors of said corporation, and that she/he signed her/she/his name to it by like order. OLE CATHERINE LANGER Notary Public Minnesota My Commission Expires Jan 31, 2023 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Laurie Pflug, Brian D. Carpenter, Jessica Hoff, Nicole Langer, Craig Olmstead, Trisha Kasper, Blake S. Bohlig, Heather R. Goedtel, Kelly Nicole Enghauser, Michelle Halter, Individually of Bloomington, MN, their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 2nd day of December, 2019. Continental Casualty Company National Fire Insurance Company of Hartford American Cast city Company of Reading, Pennsylvania Paul T. Bruflat Vice President Stale of South Dakota, County of Minnehaha, ss: On this 2nd day of December, 2019, before me personally came Paul T. Bruflat to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. My Commission Expires June 23, 2021 J. Mohr Notary Public CERTIFICATE I, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 14th day of October , 2020 Form F6853-4/2012 Continental Casualty Company National Fire Insurance Company of Hartford American Casualty Company of Reading, Pennsylvania D. Johnson f Assistant Secretary Go to www.cnasurety.com > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. P-6 NON -COLLUSION DECLARATION 0/LE60�J STATE OF A3�{|NGTO� ) MA -41..4 )ss. COUNTY OF��� ) The undersigned, being first duly svvorn, on oath states that the peraon, firm, aaauciation, partnership, joint venture, or corporation named in the Bid Proposal has (have) not, either directly or indireot|y, entered into any agreonnent, participated in any coUusion, or otherwise taken any action in restraint of free competitive bidding in connection with the City of Tukwila project,nampd,2020 CENTRAL BUSINESS DISTRICT SANITARY SEWER REHABILITATION - PH4,-Pr 91140203. .,.~'`.". '' - ' Name of Firm Signature uthorizedOffioia| '`- * 5C0 tt Wc-`.C3*S/e71k,. "eY(w* Title Signed and sworn to before m f � �_ . .1 \ ` �NntomPub|k:in��dforthaGb�eo���m����*�.ro�d SignatunaofNntoryPub|k:in��dforthaGb�eo���m����o�.ro�dingat My appointment expfres: to( t /.41 SEAL OFFICIAL STAMP DAVID RAY PHELPS NOTARY PUBLIC -OREGON COMMISSION NO. 967169 MY COMMISSION EXPIRES OCTOBER 01, 2021 To report bid rigging activities caII: NOTICE TO ALL BIDDERS 1-800-424-9071 / /t / k�p,�«- 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 riQging, bidder coUusion, 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, An information will be treated confidentially and caller anonymity will be respected. 2020 CentraBusiness District Sanitary SeweRehabilitation Phase 4 Rev. 5-13-1* P-7 RESPONSIBLE BIDDER DETERMINATION FORM Attach additional sheets as necessary to fully provide the information required. Name of Bidder: Wtt Address of Bidder: (11,S (le -Ft. City Contractor's License State No,wt1'CNe(,*99QJ.Q WA State UBI No. 9 731 — Zip Code 6)o/ 06,1 07 Dept. of L&I License Bond Registration No. 429254/32- Worker's Comp. Acct. No. ' 32 3 11 —0 0 Bidder is a(n): 0 Individual 0 Partnership 0 Joint Venture XIncorporated in the state of cc9.Z List business names used by Bidder during the past 10 years if different than above: fl A - Bidder has been in business continuously from Miesibk.rvta.l �Z Hr1 e Bank Reference aaintC- Tievst~ Bank 194,0 ear ...CAVote S AN,22kd4` Account Officer q20-921 --no 0 Officer's Phone No. No. of regular full-time employees: 40 Number of projects in the past 10 years completed: 3o0 ahead of schedule �S behind schedule 150 Bidder has had experience in work comparable to that required for this Project: As a prime contractor for 3 S years. As a subcontractor for 3S— years. on schedule List the supervisory personnel to be employed by the Bidder and available for work on this project (Project Manager, Principal Foreman, Superintendents, and Engineers): Sam N c 4 e.- e c1 r i LA 2- �yar me-6fa Title Sft. 'tnstoi' Ivla00.1e11— COns-I-rNcfion Maemlet Co nsfrµe.-1-cer ryloo,14,- 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 How Long with Bidder v (,-S 5)1LaR.s Rev. 5-13-14 Provided to Builders Exchange of WA. Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal 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)? ❑ Yes ❑ No Surveyor's Name: N /A 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 Project Name Completed Amount Owner/Reference Name and Phone 50e-- Ar-Vcricita 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 Total CIa ims Amount of Contract Arbitrated Settlement Amount or Litigated of Claims Has Bidder, or any representative or partner thereof, ever failed to complete a contract? No 0 Yes If yes, give details: H,as Bidder ever had any Payment/Performance Bonds called as a result of its work? No 0 Yes If yes, please state: Project Name Contracting Party Bond Amount 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal Responsible Bidder Determination Form P-9 H s Bidder ever been found guilty of violating any State or Federal employment Taws? No ❑ Yes If yes, give details: Has Bidder ever filed for protection under any provision of the federal bankruptcy laws or state insolvency laws? No 0 Yes If yes, give details: H s any adverse legal judgment been rendered against Bidder in the past 5 years? No 0 Yes if yes, give details: 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? l No 0 Yes If yes, please state: Date Type of Injury Agency Receiving Claim The undersigned warrants under penalty of accurate to the best of his/her knowledge. The all information contained herein. Signature of Bidder tva+;rnrrrr is-' I P(vfoegoi('ili/ Perjury;that:.the fn'g,,information is true and undersigned. a'ti orizes •#nicity of Tukwila to verify 006-4 co �5 �� s0 Title: Jl.vuIA/v,,M 2018 Central Business District Sanitary Sewer Rehabilitation c`7 ate: §;1161t1t• Rev. 5-13-14 ?rovided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-10 PROPOSED EQUIPMENT AND LABOR SCHEDULE (Use additional sheets if required) Equipment to be used: DESCRIPTION/TYPE YEAR CONDITION OWN/RENT P/e0,51-- S4..e #ft ac1ied Labor to be used: (i(1 0/-1 /iabore(s �"o be uctc , fh;s /0/0)4.c.4-. Sig}aafsu of Authorized Official • g * tea t st22 �,� , Title 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal P-11 PROPOSED SUBCONTRACTORS Name of Bidder Pat s (o aTut1,-- In accordance with RCW 39.30.060 as amended, every bid that totals Si 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 77 Schedule/Bid Item Numbers % of Name Subcontractor will perform Total Bid 140n2 2020 Central Business District Sanitary Sewer Rehabilitation - Phase 4 Rev. 5-13-14 Provided to Builders Exchange of WA. Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal