HomeMy WebLinkAbout040212_ca03
Department of Public Works
o Consent Agenda
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Jefferson County
Board of Commissioners
Agenda Request
From:
Board of Commissioners
Philip Morley, County Administrator
Frank Gifford, Public Works Director '::!fJ:l
To:
Agenda Date:
Subject:
April 2, 2012
Execution of Contract with Seton Construction, Spruce Creek
Culvert Replacement, Upper Hoh Rd. M.P. 9.70, Federal Aid
Project No. ER-0902(340), County Project No. X01821
Statement of Issue: Execution of Contract with Seton Construction of Port
Townsend, Washington for the Spruce Creek Culvert Replacement, County Project No.
X01821.
Analysis/Strategic Goals/Pro's & Con's: Heavy rainfall and high flows in Spruce
Creek in January, 2009 caused significant damage to the roadway and culvert,
requiring temporary, emergency repairs at Upper Hoh Road MP 9.7. Public Works
applied for and received funding from the Federal Highway Administration (FHWA) to
replace the existing culverts at MP 9.7 w'lth a new structure. The new structure will
be a 22 ft. span, 3-sided, concrete box culvert. This Contract is for the construction
of the new culvert.
Fiscal Impact/Cost Benefit Analysis: The Contractor's bid amount is $397,507.43.
This will be funded at 86.5% by the Federal Highway Administration, and 13.5% by the
County Road Fund.
Recommendation: Public Works recommends that the Board execute all three (3)
originals of the Contract with Seton Construction and return two (2) originals to Public
Works.
Department Contact: Mark Thurston, Project Manager, 385-9160.
rator
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CONTRACT
JEFFERSON COUNTY, WASHINGTON
THIS AGREEMENT, made and entered into this day of , 2012, 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 Seton Construction of Port Townsend. Washington 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:
1. 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:
This contract provides for the improvement of Upper Hoh Road by replacing the culvert at Spruce Creek, at
milepost 9.70 in West Jefferson County near Forks, Washington. Work includes furnishing and installing a new
22 ft. span precast, reinforced, 3-sided, concrete box culvert with precast footings and precast wing walls,
constructing and removing a temporary traffic bypass, stream restoration, repaving, guardrails, site restoration
and other work
for the total sum of Three hundred ninety seven thousand five hundred seven dollars and fortY three cents ($397.507.43
) 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: Contract time shall begin on the first working day
followinlt the Notice to Proceed Date. Bemnninlt with the first workinfJ day. the proiect shall be physically complete
within 50 workinfJ days.
. 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.
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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, retorn receipt
requested, for all of the following stated insurance policies.
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 maintsin
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 Contractual/Commercial Liability including completed operations (contractors only);
4. Premises - Operations Liability (M&C);
5. Independent Contractors and Subcontractors; and
6. Blanket Contractual Liability.
(1 )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 shalI 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
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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.
It is agreed by the parties that judgments for which the County may be liable, in excess of insured amounts
provided herein, or any portion thereof, may be withheld from payment due, or to become due, to The Contractor until
such time as The Contractor shall furnish additional security covering such judgment as may be determined by the
County.
The County reserves the right to request additional insurance on an individual basis for extra hazardous contracts
and specific service agreements.
5. The Contractor shall comply with all Federal, State, and local laws and ordinances applicable to the work to be
done under this Agreement. This Agreement shall be interpreted and construed in accord with the laws of the State of
Washington and venue shall be in Jefferson County, W A.
The Contractor shall indemnity and hold the County, and its officers, employees, and agents harmless from and
shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims,
demands, or suits at law or equity arising in whole or in part, directly or indirectly, from the Contractor's negligence or
breach of any of its obligations under this Agreement; provided that nothing herein shall require a Contractor to
indemnity the County against and hold harmless the County from claims, demands or suits based solely upon the conduct
of the County, its officers, employees and agents, and; provided further that if the claims or suits are caused by or result
from the concurrent negligence of: (a) the Contractor's agents or employees; and, (b) the County, its officers, employees
and agents, this indemnity provision with respect to claims or suits based upon such negligence, and/or the costs to the
County of defending such claims and suits, etc., shall be valid and enforceable only to the extent of the Contractor's
negligence, or the negligence of the Contractor's agents or employees.
Claims against the County shall include, but not be limited to assertions that the use and transfer of any software,
book, document, report, film, tape, or sound reproduction of material of any kind, delivered hereunder, constitutes an
infringement of any copyright, patent, trademark, trade name, or otherwise results in an unfair trade practice or an
unlawful restraint of competition.
The Contractor specifically assumes potential liability for actions brought against the County by Contractor's
. employees, including all other persons engaged in the performance of any work or service required of the Contractor
under this Agreement and, solely for the purpose of this indemnification and defense, the Contractor specifically waives
any immunity under the state industrial insurance law, Title 51 R.C. W. The Contractor recognizes that this waiver was
specifically entered into pursuant to provisions ofR.C.W. 4.24.1 IS and was subject of mutual negotiation.
6. The Contractor's relation to the County shall be at all times as an independent Contractor, and nothing herein
contained shall be construed to create a relationship of employer-employee or master-servant, and any and all employees
of the Contractor or other persons engaged in the performance of any work or service required of the Contractor under
this Agreement shall be considered employees of the Contractor only and any claims that may arise on behalf of or
against said employees shall be the sole obligation and responsibility of the Contractor.
7. The Contractor shall not sublet or assign any of the services covered by this contract without the express written
consent of the County or its authorized representative. Assignment does not include printing or other customary
reimbursable expenses that may be provided in an agreement.
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8. Nothing in the foregoing clause shall prevent the County, at its option, from additionally requesting that the
Contractor deliver to the County an executed bond as security for the faithful performance of this contract and for
payment of all obligations of The Contractor.
9. The Contractor will declare management option of the ststutory retained percentage on Exhibit B.
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IN WITNESS WHEREOF, the Contractor has executed this instrument on the day and year first below written,
and the Board of COWlty Commissioners has caused this instrument to be executed by and in the name of said
COWlty of Jefferson the day and year first above written. !
Executed by the Contractor 1fJo Idl If) . 201~
contracto:J1d,n tmskUL);on InL-
By: F ~- f$._ L~.ji..
JmAl '-I Iu;StJ,4
State ofWasbingtoD, Contractor Registration Number
COUNTY OF JEFFERSON
BOARD OF COMMISSIONERS
John Austin, Chair
Phil Johnson, Member
David W. Sullivan, Member
201 2-
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CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGmILITY, AND VOLUNTARY EXCLUSION
The Contractor certifies to the best of its knowledge and belief, that it and its principals:
(1) Are not presently debarred, suspended, proposed for debannent, declared ineligible, or voluntarily excluded from
covered transactions by any Federal department or agency;
(2) Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered
~ them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State,
or local) with commission of any of the offenses enumemted in pamgmph (2) of this certification; and
(4) Have not within a 3-year period preceding this contract had one or more public transactions (Fedeml, State, or
local) terminated for cause or default.
Where the Contractor is unable to certifY to any of the statements in this certification, such Contractor shall attach an
explanation.
d~n tl1JrJib-4n JnL.
Name of Contractor
tyU/L. , felon ~.
Name and Title of Authorized Representative
J//u. jJy t'S/d.,on I-
'&l<.__- #. 4. fl.
Signature of Authorize Representative
o lam unable to certifY to the above statement. An explanation is attached.
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CONTRACT B{Jl'<l'))
JlnrRRSON COUNTY, WASHINGTON
Bond No. 2148493
KNOW ALL Mr~ny THESBPRESfiNTS:
That ...s.r4illl~_t\l&tlt.)IL..._._............_. ofl'ort Townsend. ~lltID.ll.1f!IL_........._..... , as Plil1eipnl, and
North AmerlCl!l'-l!~~.L'1!!!:!~!l~ ColllP.!!!Y as Surety, are jointly and severally held and bound wlto t1ro COUNTY OJ'
1BFFr-:ru;;ON, the- penal SlIm of Three b!llli!m4.Bjlli:t.Y..li!t:Y.5'.llj.lli.~I!.~lli!.flVe hundred Sl..'vell <;j~lJj!tll;.\ll1g~)::.9:!ree cents
OOiL.$.f.rutl}, fot the payment of V.11icl1 we jointly llIKI severally bind ourselves,Qr heirs. exl1Cutoril,adtllini~irat0I5. and
wsigns, and sucoossors and wsigns, firmly by these presen1s.
The condition ofthis bond issucll!ltat WHEREAS, on the ._~day of....~~.~_._........__._._..., A.D., ;ro12, tbe said
Seton Construction , Principal herein, executed a e<:.'ltliTl contract with the County of JefferS',,", by tile terms,
wlJditions and provisions of \\11ieh ,:ontre..:t the sakl............~.\Jt9!LCQ.l:mIDls:.tk>.IL......__ .. :Principal herewith. agfte$
to filmisl1 aU materials and do ~'erUlin work,m-wit: Thallhe said PrllWipnl lleN:in will uudertake and complete the fL1110wiull
desl:ribOO wort.:
S~ ~k Cu~fu:1i1~l!.w.lh.:(ml.il!X.~19j~!.N.\t...KQ.!jlLf.llml&.id..t-!I}. El{-l)')Q:2Cl40) , in Jeff~l'StlJl County,
Washingtoll, .lIS per maps, plum; alld !lpeCifmaoons made lIplIrt of sald co~'t, which contract a.~ so executed, is IW.llIlln<<>
'aUll<:hed, and is now referred to and by Ihili refurcllce is inOOtjJOreted herein and made a part betl..'tlf as full for all plll'pOSIlS n.~
ifhere set fOrth mloogtb.
NOW THERE PORE. iftlle Prmcipall1erein sball tltiljltltlly and truly oh~'f\Ie and cOOlp1y with the rerltlS,COIlditilltlll
alld (lfOvisioos of said walTS!.)!, ail. all respects and shall well and truly and fully dl1 and per1om:i all matters and tIlings hy the
said Principal 'undertaken to be perthrmed under $!lid Conti'lll", UJWIl the lallls plU(lOsOO th<erein, lIIlU within the lime
pre..~ri~ dr..::reill, IIlId wrtiI ihc same is accepted, and >hall pay aI! !almrers, meclwnlcs, Slll;lconll'llctlllund 1l'lateriallThlll. and
all persons who shall supply such oontra.ctor or subcontract"'f with provisions and sup,plies tor the ClIlT}'mg OIl (lf~worl<,
and slllln in aIlrespellts faltbfully jllll'tolln said contrnct IIccording W law, dren this obligation ttl be void, otherwise 10 R-main
l11lidl filtoo and effect.
Wfl'NI,SS Ollrbands Ibis _20th \lily of. March_ ,201:1.
Seton Constroeti(l!l
PRINCIPAL
By:-4. ,./t15- ~.ft
..~~!.!!!.~!ffi!!!...~!!y'.!~!~rance Company
SURETY COMPANY
Bl~~
By:.:.~".!'!.~e"~k!~meY!!:............_.i.~._.
Attorney..in-lact .
Address of local "ffke lllld agent ".
of surety com:p3IlY:
Hentschell & AssocIates. Jne.
_621 ~!!cifI!L~".~.!!1te ~_...._.
Tacoma, WA98402
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NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
W ASlllNGTON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY TIIESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly orgaaized and existing under
laws of the State of New Hampshire, aod having illl principal office in the City of Manchester, New Hampshire, and Washington lnteroational
Insurance Company, a corporatioo orgaaized and existing under the laws of the State of New Hampshire and having its principal office in the City of
Schaumbw-g, Illinois, each does hereby make, constitute aod appoint:
THOMAS P. HENTSCHELL, BRADLEY A. ROBERTS. JULIE A. CRAKER,
KAREN A. INGRAM, KAREN J. SMITH aod JOANNE REINKENSMEYER
JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-in-Facl, to make, execute, seal aod deliver, fot and on illl behalf and as its act and deed, hands ot other writings
obligaloty in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are ot may be required or permitted by
law, regulation, contract ot otherwise, provided that no bond or undertaking or contract ot suretyship executed under this authotity shall exceed the
amount of: FIFrY MILUON ($50.000.000.00) DOLLARS
This Power of Attorney is graoted and is signed by facsimile under and by the aothotity of the following Resolutions adopted by the Boards of
Direetors of both North American Specialty Insurance Company and Washington 1nteroati0nallnsurance Company at meatiogs duly called and held
on the 24th ofMarcb, 2000:
"RESOLVED, that any two of the Presideots, any lIA"".ging Director, any Senior Vice Presideot. any Vice Presideot. any Assistant Vice Presideot,
the Secretmy ot any Assistant Secretmy be, and each or any of them hereby is authorized to execute a Power of Attorney qualifYing the attorney named
in the giveo Power of Attorney to execute on behalf of the Company hands, undertakings and all contracts of surety, and that each or any of them
hereby is aothorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers aod the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile, and any such Power of Attorney or certificate !leering such facsimile signatures or facsimile seal shall be
binding upon the Company wheo so affixed and in the future with regard to any hand, undertaking or contract of surety to which it is attached.>>
By
StlMm P. Al:td2:noll. PraIdlml & CJdefEm:mive 0ffIeer afWuhIagto.n InternatIuDal Jnsuranee Company
& Sed:Ior VIce Pre:dd1mt ul'Norlh American SpedaIty IDsuraD:e Compaay
{AC7
By ~~~
David M. LaymaD. Senfo1' Vb PreddenC orWahb:igton IaternatiouaI IDsoranee Company
& Vb Presldettt: of North AmerItaD Spedalty fIlsanmce Compsny
1~i
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IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington 1nteroati0nallnsurance Company have caused their
official seaIsto be hereunto affixed, and these preseots to be signed by theiraothorized officers this 14th day of September . 20~.
North Amerlean Specialty Insurance Company
Washington International Insnrance Company
State of Illinois
County of Cook
ss:
'.
00 thiS 14th day of September .20 11 '. before me, a Notmy Pnblic personally eppeared Steveo P. Anderson ,President and CEO of
Washington 1nteroati0nallnsurance Company and Seniot Vice President of North American Specialty lnsurance Company and David M. Layman ,
Seniot Vice President of Washington lnteroationallnsurance Company and Vice Presideot of North American Specialty Insurance Company,
personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and
acknowledged said instrument to be the voluntmy act aod deed of their respective companies.
CIFFICIAl. SI!AL
D JIlLNS.SDIl
_PUlUC.srATl!OfIllJN01ll
Ill. ,,,................2
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~ James A. Cat;penter ,the duly elected A.qjstant Secretarv of North American Specialty Insurance c.oriipany'aod Washil1gton
loteroationallnsurance Company, do hereby certity that the above nod fotegolng is a true and correct copy of a PowOFiJf Atl9rney giveo by siu,t North
American Specialty lnsurance Company and Washington 1nteroational Insurance Company, whicb is still in full forcli ind effect. '
IN WITNESS WHEREOF, I beve set my hand and affixed the seaIs of the Companies ~day 0{l'MtJ-t~ .20 1i:-: ~ ".
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North AmerIcan Specialty Jnsunmce C<nnpany-
A@@ CERTIFICATE OF LIABILITY INSURANCE ;;;:::o~
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 POUCIES
BELOW. THIS CER1lFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cerllflcate holder Is en ADDmONAL INSURED, the pollcy(los) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms end conditions of the policy, certain policies may requIre en endoreement. A statement on this cerllflcete does not confer rights to the
cerllflcete holder In lieu of such endorse s .
PRODUCER
Kuresman Insuranoe
9321 Bayshore Dr. NW
STE 111
Silverdale
INSURED
Seton Construction, Inc.
4640 Discovery Rd
,
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Tri.na Maher
. (360) 692-6131
. tr:inam8ItureSJDanins. com
FAX 0 (360) 692-6181
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 IWf REQUIREMENT, TERM OR CONDITION OF IWf CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIACATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERBN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CO NDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REaU CED BY PAID CLAIMS.
TiW TYPE! OF INSURANCE POUCY NUMBER POUCY EFF POlICY exp
GENERAL UABIU1Y
-
X COMMERCIAL GENERAL UABIUTY
A _ ~ ClAIMS-MADE [iJ OCCUR
X S'l'OP GAP LIABILXn
X LOGGERS BR01tD FORK
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WD..L BE DELIVERED IN
JEFFERSON COUNTY DEPARTMENT OF PUBLIC WOR ACCORDANCE WITH THE POLICY PROVlSIONS.
623 SHERIDAN STllEET
PORT TOWNSEND, WA 98368 AU1HORJZED REPRESENTA11VS
Mark Maberry/MliM ~4-~ ~:.--------
AFFORDING COVERAGE
Northwest Insurance Co
WA 98383-8350
INSURERA:L
Port Townsend
COVERAGES
INSURER B:
INSURER c:
INSURER D:
lNSURERE:
WA 98368 INSURER F:
CER1lFICATE NUMBER.oCLlll02001844
REVISION NUMBER:
x
::os 16-16-02
UIIIlS
$
$
$
$
$
$
$
I ~~~JNGLE UMIT .
BODILY lNJURY {Per person) $
BODILYlNJURY(Peracclrlent) $
PROPERlY DAMAGE $
$
$
$
$
1_W'...\lT~Ui;.1 Iq]);!-
$
$
$
0/30/20U
~
0/30/2012 MEDEXP(Anyone_)
PERSONAL&NN INJURY
GENERALAGGREGAlE
PRODUCTS ~COMPIOP AGG
~~,UMlTAPP.-!'!'i'PER
IPOUCYlxl~ 1 ILOC
AUTOMOBILE! UABIU1Y
-
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- ALLOWNED X $CHEDUlEO
X AUTOS 'if ~-OWNED
_ HIRED AlJTOS .:.:.. AlJTOS
::os 16-16-02
0/30/20U 0/30/2012
UJIBRBU.A UAB L!J OCCUR
A X EXCESSUAB I" 'I ClAJMS.MADE
OED 1 1 RETENTlON $
WORKERS COMPENSATION
AND EMPLOYERS" UABlUlY Y IN
ANY PROPRIETOR/PARrNERIEXECUTlVE D
OFFlCERtMEMBER EXClUDED? N I A
_,"NIl)
~~OPERATIONS below
U__
eACH OCCURRENCE
AGGREGAlE
::os 16-16-02
0/30/2011 0/30/2012
E.L EAQ-J ACCIDENT
E.L DISEASE - EA
E.L DISEASE - POUCY LIMIT
DESCRlJrTlON OF 0PERA11ONS I LOCATIONS /YEHICLES (AJIach ACORD 101. AddIfkmaI Remarks Schedu!e, If mora 8)3aC8 Is requIred)
SPRllCE CREEK COLVERT REI?LACEMENT COONTY PRQ.:JECT NO. X01S21
CERTIFICATE HOLDER IS LISTED AS lIDDITIONlIL INscro:D PER CGS416.
CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2010/05)
1N8D2S t?fl1nM\ n1
NAIC .
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
1 000 000
1 000 ODD
2,000,000
2,000,000
@)1988-2010ACORDCORPORATlON. AD rights reserved.
TJu. Ar.nRn nAma arvlltvln aft!; n:wIlcm:-nuf 1'mI"lro nf .ar.nAn