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HomeMy WebLinkAbout031212_ca03 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Philip Morley, County Administrator Frank Gifford, Public Works Director March 12, 2012 4J1 From: Agenda Date: Department of Public Works o Consent Agenda Page 1 of 1 Execution of Contract Pavement Marking on Jefferson County Roadways for Calendar Years 2012 B: 2013. Subject: Statement of Issue: Execution of a two (2) year Contract with Apply-A-L1ne, Inc. for Pavement Marking on Jefferson County Roadways for Calendar Years 2012 B: 2013. Analysis/Strategic Goals/Pro's & Con's: The Board awarded a Contract on February 6,2012. The contract provides for furnishing all labor, equipment and materials necessary to complete the pavement marking work. This program is consistent with County goals in that it provides for the safety of the motoring public on County roadways. Contractor has provided the required contract bond and insurance certificate, which are on file at the Public Works Department office. Fiscal Impact/Cost Benefit Analysis: The annual pavement marking project is included in the Public Works Department Road Operations budget. Estimated contract amount: $453,817 over two (2) years. Recommendation: Public Works recommends the Board execute the Contract with Apply-A-L1ne, Inc. and the Board is requested to sign the three (3) Contracts where indicated, and return two (2) Contracts to Publ1c Works for implementation. Department Contact: Darrel Erfle, Project Manager 385.9160 Reviewed By: "Y'7I/L- Date 121A3448 JEFFERSON COUNTY, WASlllNGTON TIIIS AGREEMENT, made and entered into this day of . 201--> betWeen the COUNTY OF JEFFERSON, acting through the Jefferson County Commissioners and the Director of Public Works under and by virtue of Title 36, RCW, as amended and Aoolv-A-Line. Inc. of Pacific. W A hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: I. The Contractor agrees to furnish all labor and equipment and do certain work, to-wit: That The Contractor herein will undertake and complete the following described work: Furnish all labor, equipment and materials necessary to complete Pavement Marking on Jefferson County Roadways for Calendar Years 2012 and 2013 for the total sum of Four Hundred Fifty Three Thousand Eight Hundred Sixteen Dollars and Sixty Two Cents ($453.816.62) in accordance with and as described in the attached plans and specifications and the Standard Specifications of the Washington Department of Transportation which are by this reference incorporated herein and made a part hereof. The Contractor shall perform any alteration in or addition to the work provided in this contract and every part thereof. The Contractor shall complete the described work as follows: Work under this contract shall commence upon written Notice to Proceed by the County to the Contractor and shall be physically complete as called out In the Specifications and Contract Documents Special Provisions. The Contractor shall provide and bear the expense of all equipment, work and labor of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in this contract and every part thereof. 2. The County of Jefferson hereby promises and agrees with the Contractor to employ, and does employ the Contractor to furnish the goods and equipment described and to furnish the same according to the attached specifications and the terms and conditions herein contained, and hereby contracts to pay for the same according to the attached specifications and the schedule of unit or itemized prices hereto attached, at the time and in the manner and upon the condition provided for in this contract. The County further agrees to employ the Contractor to perform any alterations in or additions to the work provided for in this contract that may be ordered and to pay for the same under the terms of this contract and the attached specifications at the time and in the manner and upon the conditions provided for in this contract. 3. The Contractor for himself, and for his heirs, executor, administrators, successors, and assigns, does hereby agree to the full performance of all the covenants herein contained upon the part of the Contractor. 4. Prior to commencing work, the Contractor shall obtain at its own cost and expense the following insurance from companies licensed in the State with a Best's rating of no less than A: vn. The Contractor shall provide to the County Risk Manager certificates of insurance with original endorsements affecting insurance required by this clause prior to the commencement of work to be performed. The insurance policies required shall provide that thirty (30) days prior to cancellation, suspension, reduction or material change in the policy, notice of same shall be given to the County Risk Manager by registered mail, return receipt requested, for all of the following stated insurance policies. 2012-2013 Pavement Marking Page 10f7 Contract-Revised 10l2S11I If any of the insurance requirements are not complied with at the renewal date of the insurance policy, payments to the Contractor shall be withheld until all such requirements have been met, or at the option of the County, the County may pay the renewal premium and withhold such payments from the moneys due The Contractor. All notices shall name the Contractor and identify the agreement by contract number or some other form of identification necessary to inform the County of the particular contract affected. A. Workers Compensation and Employers Liability Insurance. The Contractor shall procure and maintain for the life of the contract, Workers Compensation Insurance, including Employers Liability Coverage, in accordance with the laws of the State of Washington. B. General Liability(l) - with a minimum limit per occurrence of one million dollars ($1,000,000) and an aggregate of not less than two million dollars ($2,000,000) for bodily injury, death and property damage unless otherwise specified in the contract specifications. This insurance coverage shall contain no limitations on the scope of the protection provided and indicate on the certificate of insurance the following coverage: 1. Broad Form Property Damage with no employee exclusion; 2. Personal Injury Liability, including extended bodily injury; 3. Broad Form ContractuaIlCommercial Liability including completed operations (contractors only); 4. Premises - Operations Liability (M&C); 5. Independent Contractors and Subcontractors; and 6. Blanket Contractual Liability. (I )Note: The County shall.be named as an additional insured party under this policy. C. Automobile (2) - with a minimum limit per occurrence of $1,000,000 for bodily injury, death and property damage unless otherwise specified in the contract specifications. This insurance shall indicate on the certificate of insurance the following coverage: 1. Owned automobiles; 2. Hired automobiles; and, 3. Non-owned automobiles. (2) Note; The County shall be named as an additional insured party under this policy. Any deductibles or self-insured retention shall be declared to and approved by the County prior to the approval of the contract by the County. At the option of the County, the insurer shall reduce or eliminate deductibles or self-insured retention or The Contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. The Contractor shall include all subcontractors as insured under its insurance policies or shall furnish separate certificates and endorsements for each subcontractor. All insurance provisions for subcontractors shall be subject to all of the requirements stated herein. Failure of The Contractor to take out and/or maintain any required insurance shall not relieve The Contractor from any liability under the Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations concerning indemnification. It is agreed by the parties that insurers shall have no right of recovery or subrogation against the County (including its employees and other agents and agencies), it being the intention of the parties that the insurance policies so affected shall protect both parties and be primary coverage for any and all losses covered by the above described insurance. It is further agreed by the parties that insurance companies issuing the policy or policies shall have no recourse against the County (including its employees and other agents and agencies) for payment of any premiums or for assessments under any form of policy. It is further agreed by the parties that any and all deductibles in the above described insurance policies shall be assumed by and be at the sole risk of The Contractor. 2012-2013 Pavement Marking Page 2 of7 Contract-Revised 10125111 It is agreed by tbe parties tbat judgments for which tbe County may be liable, in excess of insured amounts provided herein, or any portion tbereof, may be witbheld from payment due, or to become due, to The Contractor until such time as The Contractor shan furnish additional security covering such judgment as may be determined by tbe County. The County reserves tbe right to request additional insurance on an individual basis for extra hazardous contracts and specific service agreements. 5. The Contractor shall comply witb all Federal, State, and local laws and ordinances applicable to tbe work to be done under tbis Agreement. This Agreement shall be interpreted and construed in accord witb tbe laws of tbe State of Washington and venue shan be in Jefferson County, WA. The Contractor shall indemnify and hold tbe County, and its officers, employees, and agents harmless from and shall process and defend at its own expense, including an costs, attorney fees and expenses relating tbereto, an claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly, from tbe Contractor's negligence or breach of any of its obligations under tbis Agreement; provided tbat notbing herein shall require a Contractor to indemnify tbe County against and hold harmless tbe County from claims, demands or suits based solely upon tbe conduct of tbe County, its officers, employees and agents, and; provided further that if tbe claims or suits are caused by or result from tbe concurrent negligence of: (a) tbe Contractor's agents or employees; and, (b) tbe County, its officers, employees and agents, tbis indemnity provision witb respect to claims or suits based upon such negligence, and/or tbe costs to tbe County of defending such claims and suits, etc., shall be valid and enforceable only to tbe extent oftbe Contractor's negligence, or tbe negligence of tbe Contractor's agents or employees. Claims against tbe County shall include, but not be limited to assertions that tbe use and transfer of any software, book, docmnent, report, film, tape, or sound reproduction of material of any kind, delivered hereunder, constitutes an infringement of any copyright, patent, trademark, trade name, or otberwise results in an unfair trade practice or an unlawful restraint of competition. The Contractor specifically assmnes potential liability for actions brought against tbe County by Contractor's employees, including an otber persons engaged in tbe performance of any work or service required of tbe Contractor under tbis Agreement and, solely for tbe purpose of tbis indemnification and defense, tbe Contractor specifically waives any inununity under tbe state industrial insurance law, Title 51 R.C. W. The Contractor recognizes tbat tbis waiver was specifically entered into pursuant to provisions ofR.C. W. 4.24.115 and was subject of mutual negotiation. 6. The Contractor's relation to tbe County shall be at an times as an independent Contractor, and notbing herein contained shall be construed to create a relationship of employer-employee or master-servant, and any and all employees of tbe Contractor or otber persons engaged in tbe performance of any work or service required of tbe Contractor under tbis Agreement shall be considered employees of tbe Contractor only and any claims that may arise on behalf of or against said employees shan be tbe sole obligation and responsibility oftbe Contractor. 7. The Contractor shall not sublet or assign any oftbe services covered by tbis contract witbout tbe express written consent of tbe County or its autborized representative. Assignment does not include printing or otber customary reimbursable expenses tbat may be provided in an agreement. 8. Notbing in tbe foregoing clause shall prevent tbe County, at its option, from additionally requesting tbat tbe Contractor deliver to tbe County an executed bond as security for tbe faithful performance of tbis contract and for paymentofall obligations of The Contractor. 9. The Contractor will declare management option of tbe statutory retained percentage on Exhibit A. 2012-2013 Pavement Marking Page3of7 Contmcl-Revised 10125111 IN WITNESS WHEREOF, the Contractor has executed this instrument on the day and year first below written, and the Board of County Commissioners has caused this instrument to be executed by and in the name of said County of Jefferson the day and year first above written. Executed by the Contractor Februarv 17 Contractor: Apply-A-Line, Inc. (please print) By: Michael Liliestrom. President (please print) ~ - -:: (Signatul'ej APPLYI*161RU State of Washington. Contractor Registration Number .".,..:.... . .' '... '- -~ . . -/\ ~/ ,-'" :..-..~ ." ~,,,......" :- -"" -',' ~ .....'. ~ ..... ~ ....... . E'-''''''-''':'-- ~- .; : j..,;." 2012-2013 Pavement Morking .201.2..- COUNTY OF JEFFERSON BOARD OF COMMISSIONERS John Austin, Chair PhiIJohnson,~en1ber David W. Sullivan, Member 1h. Approved as to form only this ~ dayof.fE:B,-tvAfl-1j .201 Z. f)~L David Alvarez ~ Deputy Prosecuting Attorney =1~ 1~it . Date P.4of7 Contract-Revised 10125/11 .f; i . . CERTIF'ICATl()NRE. G.ARDING.. . DEBARMENT,SUSPENSION,.INELI. GmILITY, AND VOLUNTARY EXCLUSION . . . ., - - ., .. . .' - .. ., - .',.' '- 1'heContractor certifies to tile best of its !aiowlec:lge. and bouer, that it lthd its. principals: (1) Are not presently de\)at'red, suspended, proposed for.debarrilent. dec1ared ineligible, or voluntarily excluded from coveredttansactions by ~y F~eral department or agency; (2) Have not within a 3-yearperiodprecelfingtbis proposal beenCQ1lvicted{)f orhada civil judgment rendered against them for conwllssion offraud or a ~offense inconn!)Ction with obtaining, attempting to obtain, or performing a public (Federal, State; or IOClil)transaction or contract under a public transaction; violation of Fecierat or State. antitrust statUteS Or connnissioJ). of embezzlement. theft, forgery, bribery, falsification or destruction of records, making false statements. or receivi!lg stolen property; (3) Are not presently indicted for or otherwise criminally orcivillYcbargedby agovemmental entity (Federal,State, or loca1) witll commill.'ljon {)f any of the ofl.'ensesenu.merated in paragraph (2) of this certification; and (4) Have ntn within. a 3-yearperiod p~gthis contl1lcthad one or more public transactions (Federal, State, or loca1)termm~ted for ~ordefault. . .. . . ,.. . . . Where . the Contractor is unable to. certifY to any of the . statements in this certification, such Contractor shall auachan exp1anation. . . ,Apply-A-Line, Inc. ~ame of Contractor r-tichael Liljestrom. President. ,. Name and Title of Authorized Representative -... ~ J .. . Signature of AlJthorize RePresentative o I am unable to certify to the above statement. An explan8tion.is attacb(,d. 2012-2013 PlM:mentMmkins PageSof1 Contract-Revise<t lOllS/II ..e..' -1> ~~ -~ CON'l'RAC):':OOND JJJ:lJ'FERSQN COtJNTY. WM'roNGTON IOfOWAU._13Y.~PR.BSEN'l'S; BOND #105728856 . That Apply-A-Une, Inc. . . . . of Pacific, WA .' . . $ Prl!lcjpal. and Travelers Casualty and Surety .Compa~ of America. $ S~..lIte ~ and $O'iel1lIlY held and b<lundunlo the COUNTY OF JEFFERSON, the penal SIIIl1 of Four Hundred F!f:lv ThreeThousan~ Eight tfundred' Dollars ($ 453.816.62 . l, tOr tile payment ofwhicbWe johitlylJlld sevenlUy \)ind 01USdW9. orbeh1, o~ admlttJsttators, and assJ&'ns. and SUccessoJS andllllSigos, firmly by these ple&entl.. 'Sixteen and 621100 . The CQD.dltlon.9ftbiabQIld is~ that~, on tllo,...- dltyof . .' A.D,,201...... thesald Apply-A-Une, Inc. .. .Prlnoipalhereill,executlldllQerta.lnCOllh'aotwiththe~of.ret'furson,by~ terms, conditionS and provisions ofwliich~the said ADDlv-A-L1ne. Inc. .Prlnoiplll hOMVlth, agreei to fumlsh allD'lat$ials and docertaJn wotlc.>>-wlt: Tbatthe$8ill Priilcipal herclln win ~e and oompletethe follOWing, de$crlbed w~. . I,"$tisb all is,l;/or. eq,ui\)ment and tnaterialil necessarv. to ClIIYl111ete Pavoment Markin" 'on JeffersOn Cgililjy . Roadways for Calendl!!' y~ 201~ i\114 ~~J3 In Jefferson Count.Y. WtISblngton; atl pet IlIlIpl!. plans and specificatitm$ ~ a pan Ilf $8ill eQl1tI'lICt, whWh ~~ SQ ~1Il ~ ~ lJIldlsriowrefetted to 8.!Iliby tllis reference is ~het'eltt and .iJIllde a ~ hereof $ full t<<lnll p!IlpC)SeSulf here set with at lengih. NOW THERBFoRE.lftl1e Principal_In stiliI1 feiliifully and truly observe and comply wl1hthe terms,.condJti. and provisions of se.id COlllracI;. in all respects and shaJt weI1lm<i truly and t1illY do and penornl a1l tIIat:lCts and tblngs hythe se.ill Principal .\UldertaI@ to hIl FfOl'll:le(l under said w1ili'aot, upon the mms prD!lOsed !hereill, and within .tJ>> timO prescn'bedthetein, and until the $IIDlC is ~ lI11d sblI1I pay all laborers, ~ Ji1lboontracIOl'S and mateJialrnen, and iillpersons who sbIlllSQpply such coJ1trsetor-Of subconlnlclor with provi$lons. and SUf1P~ for theQlUlYing ollofsueh wOlk; . and!lliall in aU res~fai1;bfbIIYp"'.fI)1IU $8ill ~ ~ to laW, then thIIlobU$lllOlftobeVll1d. othetwiseto remain in fiillfurce and effect. WITNEsSoiIrltandsthlsJL.<Il1yof F&8(1.u.~~" .2Q{L.. , Apply-A-Une, Inc. PRINCIPAL ~ ~ Michael Lilj estrom President - '-:~J~-::"'f -By; Jim S. Kuich . . :::: t.! . . .-,... . Attorney..in..faQt -\~c \ 1 ~-! Address Qt'!oelll ofl'U;e and agent of sure1yCOll1Jl8lly: :;.;., .J -..~ ~ .~ ~ j:'~~.'~~ ~ \ ..- ...~"'~:;:. -~:'~I.j~ YE: . ~, '~<~~,~~- HUB Norti1wElst, LLC PO Bex 3018 Bethell, WA 98041-3018 2(l12.2{)13J'8V~~ Pogo 6 of? ~Joa5lU WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER ... TRAVELERSJ POWER OF ATTORNEY Farmington Casualty Compan}' Fidelit~' and Guaranty Insurance Company Fidelit)' and Guarant)' Insurance Underwriters, Inc. St. Paul Fire and l\'tarine Insurance Com pan}' St. Paul Guardian Insurance CompanJ' St. Paul Mercur)' Insurance Com pan}' Tra\'elers Casualt}' and Suret)' Compan)' Tra\'elers Casualt}' and Suret}' Com pan)' of America United States Fidelit}' and Guarant)' Company Attorne}'-In Fact No, 224156 Certificate No. 0 0 4 6 0 8 9 5 9 K~OW ALL 1':tEN HYTHESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian In,.;,urance Company and St. Paul Mercury Insurance Company arc corporations duly organized under the laws of the State of ~1innes()ta, that Farmington Casualty Company. Travelers Casualty and Surety Company. and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporalion duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters. Inc., is a corporation duly organized under the laws of the State of W'isconsin (herein collectively called the "Companies"). and that the Companies do hereby make. constitute and appoint Darlene Jakielski, Julie M. Glover, M.J. Cotton, Nancy J. Osborne, S.M. Scott, Steven K. Bush, Michael A. Murphy, Jim W. Doyle, Brandon K. Bush, Andy D. Prill, Jim S. Kuich, Chad M. Epple, Steve Wagner, Theresa A. Lamb, Brett N. Meier, and Ellen M. Bell of the City of Rothell . State of Washington . their true and lawful AttorneY(R)-in-Fact, each in their separate capacity if more than one is named above. to sign, execute. seal and acknowledge any and all bonds. recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the perfonnance of contracts and executing or guaranteeing bonds and undertakings required or pcnnitted in any actions or proceedings allowed by law. [I\'" WITNESS \-VHEREOF. the Companies have caused this instrument to be signcd~d tl~{ corporate seal:,; to be hereto affi.xed. this day of October ,2011 . ., ? 26th Farmington Casualty Company "" Fidelit}. and Guarant}. Insurance Compan}' Fidelity and Guarant}' Insurance'Underwriters, Inc. St. Paul Fire and Marine Insurance Com pan)' St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Tr~n'elers Casualt)' and Surety Com pan}' Tra\'elers Casualty and Surety Com pan}' of America United States Fidelit)' and Guaranty Company ~ ~ State of Connecticut City of Hartford ss. By: 26th October 2011 On this the day of . before me personally appeared George W. Thompson. who acknowledged himself to be the Senior Vice President of Fannington Casualty Company. Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters. Inc.. St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul !vlercury Insurance Company, Travelers Casualty and Surery Company, Travelen; Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he. as such. being authorized so to do. executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness \\'hereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2016. ~CT':':h~'~ 58440-6-11 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Undcrv"riters, Inc.. St. Paul Fire and Marine Insurance Company. S1. Paul Guardian Insurance Company, S1. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are nmv in full force and effeCl. reading ~ follows: RESOLVED. that the Chainnan, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys~in~Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and mher writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chainnan, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officen. or employees of this Company. provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary: and it is FURTHER RESOLVED, that any bond. recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance. or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman. any Executive Vice President. any Senior Vice President or any Vice President, any Second Vice Presidem. the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary: or (b) duly executed (under seal, if required) by one or marc Attomeys~in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officeTI': President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President. any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys~in~Fac{ for purposes only of executing and attesting bonds and undertakings and mher \vritings obligatory in the nature thereof, and any such Power of Attorney or ceIlificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E, Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., S1. Paul Fire and Marine Insurance Company, SI. Paul Guardian Insurance O)mpany. 51. Paul Mercury Insurance Company, Travelers Casualty and Surety Company. Travelers Casualty and Surety Company of America, and United States Fidelity: and Guaranty Company do hereby ceIlify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force and effect and has not been revoked, IN TESTI:\10:"<lY WHEREOF, I have hereunto set my hand and affixed the ~als of said 90mpanies this I ~ day of F[:Rllull:P.. Y ,20~ f:" tary e @ To verify the authenticity of this Power of Anorney, call 1~80()~421~3880 or contact us at v..'ww,tra\'elersbond.com. Please refer to the Attorney~In-Fact number, the above.named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVAUD WlTHOUTTHE RED BORDER This Power of Attorney is graD1ed 1IDder and by the authority of the following resolutions: adopted by the Boards of Directors of Farmington Casualty Company, fidelity and GUlI1'8pty Insurance Company, Fidelity and Guaamty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St Paul Gl1llIdlan Insuranoo Company, St Paul Meromy Insurance Company, '!\avelm Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United Stales Fidelity and Guaamty ~y, wbicb resolutions are now in full fcree and effect, reodiug as follows: RESOLVED, that the n.RlTmRn the President, any Vice Cbalnnan, any Executive Vice President, any Senior Vice President, any Vice President, any Seonnd Vice President, the Treasnrer, any Assistant Treasurer, lbe Corporate SecreImy or any A~t SecreImy may appolnt Attorneys-In-Fact and Agents to act for and on behalf of the Company and may give sucb appolntee such antborlty as his or her certificale of authority may pres<:ribe to sign wilb the Company's name and seal wilb !be Company's seal bonds, recognizances, contracts of indemnity, and other writings obllgatOIy in lbe natnre of. bond, recognizance, or conditional undertaklng, and any of said officers or the Board of Directors at any tbne may remove any sucb appointee and revoke the power given him or her; and it is FURTHER. RFSOLVED. that the rhAinnAn the President, any Vice C"hAinnAn any Executive VICe President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing antbutity to one or mora officers or employees of tbis Company, provided that each such delegst10n is in writing and . nopy tbereof is filed in the ofIice of the SecreImy; and it is ' 'lJKniJ<K RESOLVED, !bat any bond, recognizance, nontmct of indemnity, or writing obllgatOIy in the natnre of 0 bond, recognizance, or conditional undertaking sbeIl be valid and binding npon lbe Company whee (0) siJlned by the President, any Vice n.mnnon any Executive Vice President, any Senior Vice President or any Via> President, any Seonnd VICe President, the Treasurer. any Asalatant Treasurer, the Corporate SecreImy or any Assistant SecreImy and duly _ and seaIad wltb !be Company's seal by. Secretary or Assistant SecreImy; or (b) duly execnted (under seal, if reqnired) by one or mora Attomeys-in-Fact and Agenlll pur8IllUll to the power pres<:ribed in his or her certificale or tbelr certificates of antborlty or by one or more Company officers pur8IllUll to 0 written dalagatlon of antborlty; and it Is FURTHER. RESOLVED, !bat the signamre of eaab of the following officers: President, any Executive Via> President, any Senior VICe President, any Vice President, any Assistant Vice President, any SecreImy, any Assistant SecreImy, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certiflcate relating thereto appoiuting Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of execntlng and attesting bonds and undertakings and other writings obllgatOIy in the natare tbereof, and any ancb Power of Attorney or certificale beering snob faesimlle signamre or facsimile seal sbeIl be valid and binding npon the Company and any such po_ so execnted and certified by such facsimile signamre and facsimile seal sbeIl be valid and binding on the Company in the future wltb respect to any bond or uutierstaoding to wblcb it is attacl1ed. r. Kevin E. Hughes, the ondersigned, Assistant SecreImy. ofF"",,;n@<m CasnaIty Company, Fidelity and Guaamty Insurance Company, Fidellty and Guaamty Insurance Uutierwrlters, Inc., St Paul Fire and Marlne Insurance Company, St Pan! Gl1llIdlan ~ Company, St. Paul Meromy Insurance Company, Travelers Casualty and Sorely Company, Travelers CasnaIty and Surety Company of America, and U~ Fidplj1!l'and q,llA"'Y Company do hereby certify !bat the above and foregoing is . trne and 00IreCt copy of the Power of Attorney execnted by said~\i\iI,j~t- ~~~~effect and bes not been revoked. <,,,,,'t'>' "~~ ~~' ", ^~ "I'" < ~'LY <S 'j,"- \~'It' IN TESTIMONY WHEREOF, lbeveberenato8Olmybead.~~.}~~i",tbis 17- deyof Ft:Jlliu~tt 'f :\O~> O..~5 'Jf,;{:t~ ~S.. ~~ C~c ~, l' .20}2,. ~~ff::t: e@)(i) e, ~9 .~ ~ ~ To verify the antheuticity of tbis Power of Attomey. call 1-8OlJ.421-3880 or contll<:t ns at www.travelersbond.oom. Please refer to the Attorney-In-Fact nnmber. !be abc_named individoals and the details of the bond to whicb the ~ is attacl1ed. WARNING: THIS POWER OF grQRNEY IS INVAUD WlTHOUTTHE RED BORDER EXHIBIT A CONTRACTOR'S DECLARATION OF OPTION FOR MANAGEMENT OF STATUTORY RETAINED PERCENTAGE A. I hereby elect to provide a Retainage Bond for the retained percentage of this contract until (30) days following final acceptance of the work. Sign~. ~-:: --- Micha€.r Liljestrom, President B. I hereby eleCt to have the retained percentage of this contract held in a fund by the Owner until (30) days fonowing final acceptance of the work. Date 02/17/12 Date Signed C. I hereby elect to have the Owner deposit the retained percentage of this contract in an interest bearing account, not subject to withdrawal until after final acceptance of the work. Date Signed D. I hereby elect to have the Owner invest the retained percentage of this contract from time to time as such retained percentage accrues. I hereby designate as the repository for the escrow of said funds. I hereby further agree to be funy responsible for payment of an costs or fees incurred as a result of placing said retained percentage in escrow and investing it as authorized by statute. The Owner shan not be liable in any way for any costs or fees in connection therewith. Date Signed 2012-2013 Pavement Marking Page 7 of7 Contract-Revised 10125111 .. Bond No. 105728857 RETAlNAGE BOND KNOW ALL MEN BY THESE PRESENTS that we Apply-A-Line, Inc. . a corporation under and by virtue of the laws of the State of Washington and authorized to do business in the State ofWasbington, as Principal, andTmveIers ~Iy.andsurety . a Cv~J' ...r4.........~__ corpomtion organized and existing under the laws of the State of Connecticut and authorized to transact business of surety in the State of Washington, as Surety, are jointly and severally held and bound unto County of Jefferson hereinafter referred to as Obligee, as Obligee, and are llimil'lrly held and bound unto the beneficiaries of the trust fund created by RCW 60.28 and their heirs, executors, lIdministrators, successors and assigns, in the penal sum of TWENTY-TWO THOUSAND SIX HUNDRED NINETY AND 83/l00THS Dollars (. $22,690.83 ) plus 5% of any increases in the contract amount that have occurred or may occur, due to change orders, increases in the quantities or the addition of any new item of work. WHEREAS, on the day of , herein executed a contmct with Countv of Jefferson , the said Principal for Pavement Markings on Jefferson County Roadways for Calendar Years 2012 & 2013, County Project No. 1805421897 WHEREAS, said contmct and RCW 60.28 require the Obligee to withhold from the Principal the sum of 5% from monies earned by the Principal on estimates during the progress of the work, hereinafter referred to as earned retained funds. WHEREAS, the Principal has requested that the Obligee accept a bond in lieu of earned retained funds as allowed under Chapter 60.28 RCW. NOW THEREFORE, this obligation is such that the Surety, its successors and assigns are held and bound unto the Obligee and unto all beneficiaries of the trust fund created by RCW 60.28.011(1) in the aforesaid sum. This bond, including any proceeds therefrom, is subject to all claims and liens and in the same manner and priority as set forth for retained percentages in Chapter 60.28 RCW. The condition of this obligation is also that if the Principal shall satisfy all payment obligations to persons who may lawfully claim under the trust fund created pursuant to Chapter 60.28 RCW, to the Obligee, and indelDl1ifY and hold the Obligee harmless from any and all lost, costs and damages that the Obligee may sustain by release of said retainage to the Principal, then this obligation shall be null and void, provided the Surety is notified by the Obligee that the reqnirements ofRCW 60.28.021 have been satisfied and the obligation is duly released by the Obligee. ", t \ c;:' ~ Retainage Bond No.1 05728857 Page 2 of2 IT IS HEREBY DECLARED AND AGREED that the Surety shall be liable under this obligation as Principal. The Surety will not be discharged or released from liability for any act, omission or defenses of any kind or nature that would not also discharge the Principal. IT IS HEREBY FURTHER DECLARED AND AGREED that this obligation shall be binding upon and inure to the benefit of the Principal, the Surety, the Obligee, the beneficiaries of the trust fund created by Chapter 60.28, Revised Code of Washington (RCW) and their respective heirs, executors, administrators, successors and assigns. IN WITNESS WHEREOF, said Principal and said Surety have caused these presents to be duly signed and sealed this J?- day of FER~IJ.(I:R. " ,:JD /2- Apply-A-Line, Inc. ~ ~ ..>- ~ Michael Liljestrom, ~ .... ~ - - - -, ;::,:-' ~:~.<:-: ;. .- P~iJi'i8t, .~ ~....., ~ CIP~.\.:-,;:~."'" =.' ~5>_..~. Travelers Casualty and Surety Company of ~ America Surety . ByQ~~ )i~~..';;., Jim S. Kuich AttorJ~i-~-fmi .t -c ~ ~ .--._ '" WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER ., ..... TRAVELERSJ POWER OF ATTORNEY Farmin~ton Casualt)' Company Fidelit)' and Guaranty Insurance Compan)' Fidelit)' and Guarant)' Insurance Cnderwriters, Inc. St. Paul Fire and l\'larine Insurance Company S1. Paul Guardian Insurance Compau)' Attorne}'-In Fact No. 224156 St. Paul :\olen.'ury Insurance Company Travelers Casualty and Suret;,; Com paul" Travelers Casualty and Surety Compan)" of America Cnited States Fidelit}' and Guarant)' Company Certificate No. 0 0 4 6 0 8 9 6 2 KNOW ALL MEN" BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Fannington Casualty Company, Trave]ers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organizcd under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under thc laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of 100va, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of \Visconsin (herein collective]y called the "Companies"), and that the Companies do hereby make, constitute and appoint Darlene Jakielski, Julie M. Glover, M.J. Cotton, NancyJ. Osborne, S.M. Scott, Steven K. Bush, Michael A. Murphy, Jim W. Doyle, Brandon K. Bush, Andy D. Prill, Jim S. Kuich, Chad M. Epple, Steve Wagner, Theresa A. Lamb, Brett N. Meier, and Ellen M. Bell of the City of Bothell , State of Washington . their true and lawful Auomey{sHn+Fact, each in their separate capacity if more than one is named above, to sign, execute, sea] and acknowledge any and all bonds, recogniz.ances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or pemtitted in any actions or proceedings allowed by law. , IN WITNESS WHEREOF, the Companies have caused this ins~rlilTient to' be signed and their corporate seals to be hereto affixed, this October 2011 ""~ ", day of ,. '" 26th Farmington Casualtv <::o~,pan}' Fidelit)' and Guaraniy Insuranc{tE~)~1panY0lC 1 Fidelity and Guaranty Insurance Underwriters, Inc. S1. Paul Fire and Marine Insurance Compan)' S1. Paul Guardian Insurance Compan)' ~ ~ State of Connecticut City of Hartford ss. St. Paul ~1ercuI1; Insurance Compau)' Travelers Casualty and Suret)' Compan}' Tra"elers Casualt}' and Suret}. Compan)' of America Cnited States Fidelit.,.. and Guarant)' Compan)' By: 26th October 2011 On this the day of , before me personally appeared George '0/. Thompson, who acknowledged himself to be the Senior Vice President of Fannington Casualty Company. Fidelity and Guaranty Insurance Company, Fidelity and Guaranty [nsurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Ca~ualty and Surety Company, Travelers Casualty and Surety Company of America, and L'nited States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained hy signing on hehalf of thc corporations by himself a~ a duly authorizcd officer. In 'Vitness ''''hereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 20]6. 58440-6-11 Printed in U.S.A. 'f(\ . ~c. c.j~ Tetreault. Kotary Puhlic WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER Hl I' WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Fannington Casualty Company, Fid~lity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and IVlarine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Ca'\ualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company. which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chainnan, the President, any Vice Chairman. any Executive Vice Presidcnl. any Senior Vice President. any Vice President, any Second Vice President, the Treasurer. any Assistant Treasurer. the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chainnan, the President, any Vice Chainnan. any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the oftlce of the Secretary; and it is FURTHER RESOLVED. that any bond. recognizance. contract of indemnity, or writing obligatory in the nature of a bond. recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President. any Vice Chainnan, any Executive Vice President, any Senior Vice President or any Vice President. any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RE.."!:OLVED, that the signature of each of the following officers: President, any Executive Vice President. any Senior Vice President. any Vice President, any Assistant Vice President. any Secretary. any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Fannington Casualty Company. Fidelity and Guaranty Insurance Company, Fidelity <lnd Guaranty Insurance Underwriters, Inc.. S1. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, SI. Paul Mercury Insurance Company, Tra,;elers Casualty and Surety Company, Travc(crs Casualty and Surety Company of America, and United States Fidelity, and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies. which:}s in full force and effect and has not been revoked. IN TESTIMONY \-\'HEREOF. I have hereunto set my hand and affIxed the scaL~ of said Companies this J::;' day of F~8R1J.A{{ 'I .20 LZ f:" tary e ~ ~ To verify the authenticity of this Power of Attomey, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-In-Pact number, the above-named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER . I;r '" WARNING: IS POWER OF JiITORNEY IS INVAlID WITHOUTTHE RED BORDER This Power of Attomoy Is gmnted UlldOr and by the authorlty, of the following resolutions aOOpted by the Boards of Directors ofPannIngton Casualty Company, Fidellty and Guanmty In"""""" Company, Ftdclity and Guaranty insunm<:e Underwrltem, 1ne., SI, Pan! FIre and Marine insunm<:e Company, SI, PllII! GnanlIan insunm<:e Company, SI, Pan! Mercmy insunm<:e Company, 1\'aveters Casualty and Surety Company, 'navelers Casualty and Surety Company of America, and United Stales Fidelity and Guanmty Company, which resolutions are now ill full fotee and elfeol reading .. fulIows: RESOLVED, that the '""""=- the President, any Vine Chairman, any Exeoutive Vice President, any Senior VICe President, any Vice President, any Seoond Vine President, the Treasorer, any AssIstant Treasorer, the Cozporate Secretmy or any Assistant Secretmy may appoint Attorneys-ilI-Fant and Agents to ant for and on bcl1alf of the Company and may give such appointee suob anthority .. his or her certificate of authority may prescribe to sign with the Company', name and ses1 with the Company', ses1 bonds, recogr>!""'''''', 00llIl:Bl:ts of indemnhy, and nthat writings obligatory ill the nature of a bond, recognlzanoe, or oonditlonal nndeI1akIng, and any of said officers or the Bosrd of Dlrectors at any time may remove any suoh appointee and revoke the power given him or her; and it Is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Exeoutiyo Vice President, any SenIor Vine President or any Vice President may deIagate an or any part of the foregoing authority to one or more officers or employees of this Company, provided that each suoh delegation Is in wtlting and a copy thereof is Iiled in the office of the Seorelmy; and it is FURTHER RESOLVED, that any bond, recognlzanoe, oontraot of indemnhy, or wtltlng ohllgatoty in the nature of a bond, reoognizanre, or oondItlonal undertaklng shall bo valld and binding upon the Company whan (a) signed by the Pres1denI, any VlOO ChaJnnan, any Exeoutive Vine Pres1denI, any Senior Vine President or any Vine President, any Seoond Vine President, the Treasurer, any Assistant Treasurer, the Cozporate Seorelmy or any Assistant Secremy and duly attested and ses1ed with the Company', ses1 by a Seorelmy or Assistant Seoretary; or (b) duly executed (under sea1, 1frequ1red) by one ormoreAttorneys-in-Fant and Agents pursuant to the po_ pre'Clihed in his or her certificate or their certificates of authority or by one or more Company oflioers pursuant to a written delegation of authority; and it Is FURTHER RESOLVED, that the signature of eaoh of the following offioers: Presillent, any Exeoutive Vice President, any SenIor Vine President, any:vice President, any Assistant VICe Pres1denI, any Seorelmy, any Assistant Secretmy, and the ses1 of the Company may be affixed by fsesimlle to any P.- of Attorney or to any certificate relating _ appointing Resident Vine Presidenls, ResIdent Assistant SecretarIes or Attorneys-in-Fant for _ only of execntlng and attesting bonds and underlakings and nthat writlags obligatoty ill the nature thereof, and any such Power of Attorney or certificate bearing suoh faesimile signature or fsesimlle seal shall be valld and binding upon the Company and any suoh power so exectaed and certified by 'lIOh fiu:simile signature and fiu:simil. seal shall be valid and binding on the Company in the fotore with respect to any bond or underatanding to whiob it is atOlObed. L Kevin E. Hughes, the undersigned, Assistant sOcretary, ofFamtlngton Casua1ty Company, Ftdclity and Guanmty insunm<:e Company, Fidelity and Guanmty insunm<:e Uru1erwrlters.luc.. St. Pan! FIre and Marine insunm<:e Company, S1. Pan! Guardian,!psl!!aJ1OO C9mPany, S1. Pan! Mercury Iusorauoe Company, 'nave1ers Casua1ty and Surety Company,1\'ave1ers Casua1ty and Surety Company of AmerIca. and U~'~ q~ty Company do hereby certify that the above and foregoing Is a tnJe and correct copy of the Po_ of Attorney executed by said :?~~~ iMll ;"'iF;~",r e1feot and has not been revoked. ",i'\~" (J~~\" ""1;;;"\>" ::\'v I' 'l" ..; ~> ,~". INTESTJMONYWBEREOF,Ihav.hansnuusetmybeud"1l'\~.h....aJ,~~esthls 1=1- dayof FEBiW.AA.Y .20!Z "\_'P; ~)--V ~"(;--,r^,,~ :~ff~' . ~')\ ff~" .\\~',<\\\')- *"\J-) V C~~_ ~<.,\ " ,\,-0 17- ~ r. ~",,"'l ...' t- Kevin E. Hughes, Assistant tary G)@)(I) ~ e 10 verify the _th~rlMty of this F.- of Attorney, oe1l1-800-421-3880 or ooUlaot us at www.treve1ersbeud.oom Please refer to the Attorney-In-Fant number, the above-named lndivldusls and the details of the bond to which the power is atOlOhed. WARNING: THIS POWER OF JiITORNEY IS INVALID WITHOUTTHE RED BORDER . -~ OPID:MA A~RD. CERTIFICATE OF LIABILITY INSURANCE DA~~ THIS CERTIFICATE IS I88UED 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 POUC1E8 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 certllJcete heldtr Ie en ADDmONAL INSURED, the pollcy(les) must be endoreed. If SUBROGATION IS WAIVED, subject to the tsime and condlUons of the policy, certain policies may require en endorsement. A ststsment on this certlflcete does not confer rights to the certllJcete holdar In lieu of such endorseme s. PRODUCeR 426-489-4500 Hub International Northwest 426489-4501 P. O. Box 3018 BotheIl, WA 98041-3018 Steve Scott No. INSURED Apply-A-Une, Inc. 176 Roy Road SW, Bldg C Pacific, WA 98047 I AFFORDING COVERAGe INSURBRA:Travelera Indemnl CO INSURBR s: Travelers IndomnI Co of CT JNBURBR c: INSURBR 0: JNBURBR e: RERF: NAlC, 26666 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER' . THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTV\ffilSTANDING ANY REQUIREMENT. TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO AILL THE TERMS. . ! EXCLUSIONS AND CONDmONS OF SUCH == UMITS SHOWN MAY HAVE BEEN ~ PAID CLAIMS. ~-lll' . lYPEOFJNSURANce DnUCYN\lMBER ~ UI!1T8 1,000,000 GENERAL UAIlIUlY EACH OCCURReNce $ A X COMMeRClALGENERALlIABDJlY DTC0347K6614IND11 03131111 03l31112~, $ 300,000 I Cl1IIMS-MADE 00 OCCUR MEa EXP (Any one """"'" $ 6,000 -,,- PERSONAl &MV tNJURY $ 1,000,000 X WA Stop Gap LIab. GENERAlAGGREGATE $ 2,000,000 ~ 2,000,001 JifAG~mUMITn,F~ PRODUCTS ~ COMPtO? AGG $ FOllCY X ':lW; LOC $ AUTOMOIllU! UABIU1Y COMBINED SINGLE LIMIT $ 1,000,001 - (Ea-) B ..!. ANt AUTO OT810347K8614TCT11 03/31111 03131112 BODILY1NJURY (per_> $ - ALL OWNED AUTOS BODILY INJURY (For _ $ X BCHEDULED AUTOS PROPERlY DAMAGE H!REO AUTOS (Per_> $ -= ..!. NON-OWNED AUTOS $ $ UMBRELlA LIAS H~E EACH OCCURRENCE $ - excess UAB AGGREGATE $ - DEDUCTIBLE $ RETENTION . $ WORKERS COMPENSAnON we STATU-, I X I OJ;!;'" A AND EMPLOYERS" LlABJl"ITY Y / N DTC0341K6614IND11 03131111 0:f131112 " 1,000,00 AN'( PROPRlETORlPARTNERIEXECUTIV D E.L EACH ACCIDENT $ OFFlCERlMEMBER EXClUlJED? NfA E.L DISEASE" EA EMPLOYE! $ t_InNHI 1,000,00 wm _under 1,000,00 o SCRiPTiON OF OPERAnONS beIow E.L DISEASE - POUCY lIMIT. $ DescRJP110N OF OPERAnONB I LOCAnONS/VEHlCLES ~ ACORD 101. Addlllonal Ramark8 SaheduIe, If more apace Is requ1red) IT IS AGREED THAT THE CERTIFICATE HO ER IS INCLUDED AS ADDmONALINSURED AS REQUIRED BY WRITTEN CONTRACT SUBJECT TO POUCYTERMS, CONDmONS, UMITAnONSANDATTACHEDENDORSEMENT. ~~: PAVEMENT ~~N-l\~~ JEFFERS~~I cq~WV ROADWAYS FOR CALENDAR YEARS 2012 NO 2 ECT O. 7' A344B CERTIFICATE HOLDER CANCELLATION JEFFERS SHOULD ANY OF THE A1BOVE DESCRIBED POUClES BE CANCEllED BEFORE JEFFERSON COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 623 SHERIDAN STREET PORT TOWNSEND, WA 98368 AUTHORIZED REPRESENTATIVE , h~ ACORD 26 (2009109) @19B8-2009ACORDCORPORATlON. All rights reserved. The ACORD name and logo are reglstsred mBrks of ACORD "":--",--= :" . COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modlfles Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (SeolIon II) Is amended 0) to lneIude any parsen or organization thet you agrae In a 'written contra<:! requiring Insurance" to Include es an eddltlonal Insured on this Covar- age Pari, but: aJ Only with respect to liability for "bodily Injury", "property damage" or "parsonaIInJury"; end b) If, and only to the e>danl thst, the Injury or damage Is caused by acIIs or omissions of you or your subcontractor In the performance of "your work" to whlch the 'wrIlIen conlraOt requiring Insursm:a" applies. The parsen or organization does not qualify es an additional Insured with respect to the Independent acIIs or omissions of such paraen or organlzallon. 2. The Insurance prll'llded to the additional Insured by this andorsement Is limited as foIIOWll: a) In the event that the UmIts of Insurance of this Coverage Pari shown In tha DacIal1lllons exceed the nmlts of Uabnlty required by the 'written contract requiring Insuranca", the In- surance prll'llded to the additional insured ahaIl be limited to the limits of lIeblllty re- quired by that 'written contract requiring In- suranca". This endoraement shall not in- crease the limits of Insurance described In Secllon JU - Umits Of Insurance. b) The Inswance prll'llded to the additional In- sured does not app1y to "bodily Injury", "pr0p- erty dsmege" or "parsenalInJury" arising out of the rendarlng of, or failure to render, any professional architectural. engineering or sur- veying servlcas, lneIuding: I. The preparing, apprcvlng, or falling to prepare or approve, maps, shop draw- Ings, opinions, reports, surveys. fleld or- ders or change orders, or the preparing, approving, or faffing to prepare or ap- prove, drawings and apaclflcatlons; and II. SUparvlsory, lnspaclIon, erchitectural or engineering acllvlllea. The Insurance prll'llded to the additional In- sured dcas not apply to "bodily Injury' or "property damage" caused by "your work" end included In the "products-complatad op- aratlons hazard" unlesa tha 'written conlraOt requiring lnaurance" spaclIIcaIIy requires you to prll'llde such oovaraga for thet addltlonsl Insuned. and then the insuranca provided to the additional Insured applies only to such "bodlly Injury' or "prcparty damage" that oc- curs before the and of tha pariod of time for which the "written contra<:! requiring Insur. ance' requires you to provide such coverage or the and of the poUoy period, whichever Is earlier. 3. The Insurance providad to the additional insured by this andorsement Is excess over any valid end ooJ1eclIble 'other lnauranoa', whether primary, excass, contlngant or on any other basis, that Is aveUable to the eddltlonal Insured for a loss we caver under this endorsemanL However, If the "written contract requiring Insurance" spaclflcally requires that this Insurance apply on a primary basis or a primary and non-oontrlbutory basis, lhls Insurance Is primary to 'othar Insurance' available to the additional insured which covers thet pareon or organization es a named Insured for such loss, and we will not ahara with that .other Insurance". But the Insuranca prll'llded to the eddltlonallnsured by this endorsement still Is excess over any valid and coileollble "other in- surance", whether primary, excass, contingent or on any other beals, thells avaJlabla to the addi- tional Insured when that paraen or organization Is an additional Insuned under such "other Insur- ance-. 4. As a condition of coveraga provided to the addlllonallnswad by this endorsement: a) The additional Insuned must give US wrItIan notice as soon es practicable of an "occur- rence' or an oflense which may reauK In a oIafm. To the extant possible, such notice should Include: CG 02460805 @2OO5 The St Paul Travelers Companies, Inc. Page 1 of2 COMMERCIAL GENERAL UABILITY I. How. when and where the "occurrence" or ofIel1lla took place; IL The names and addresses of any Injured persons and wIlnes8ee; and In. The.nalun> endlocatfon of any Injury-OJ' demage arlslng out of the "occurrence" or ofIens&. b) If a clelm Is made or "sui\" Is brought ageInst the addlllonallnsurad. the addlllonallnsured must I. ImmadletsJy record the specIlIos of the cleIm or "suit" and ths dele received; end II. Notify us as soon as precllcallle. The addlftonallnsured must see to ft that we recelve written no1lee of the cleIm or"suIt" as soon as precllcable. G) The addIftonaI Insured must Immadtately send us copies of alllegaJ pspsrs received In connection with the claim or "sull". coopsreIe with us In the lnveslIgefton or seIIlernent of the claim or defense agalnslthe "sull". end olherwIsa comply with all poRcy oondIlIons. d) The eddlllonal Insured must tender the de- fllnsa and Indamnlty of any claim or "sui\" to ~ ~. ; any prcvlder of "other Insurenca" which would cover the addlllonal Insured for e loss we cover under this andorsamanL However. this oondIlIon does l1lll affect whether the Insur- anea provided to the addlllonal Insured by lhls endorsement Is primary1o-"other Insur- anea" aveIIabIa to the addIftonaI Insured which covers that pslSOrt or organization as a named Insured as descrlbed In paragrepb 3. above. 5. The foRowIng deflnlUon Is addad to SECTION V. - DEFINITIONS: "WrIllan contract requiring insurance" means that part of any wrltlen contract or agreement under which you are required to Include e person or orga. iIdlliou as an addllIonaI in. sured on lhls Covarsge Part. provided that the "bOOBy Injury" and "properly demaga" oc- ours and lIla "parsonallnjlllY" Is causad by an oIIeI1lla commllted: B. After the sIgnlng and execution of the contracl or agreement by you; b. WhIle that part of the contracl or agraemant Is In affecl; and c. Before the and of the poDcy period. Page20f2 C 2005 The 51. Paul Travelers companies, Inc. CG 0246 08 05