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HomeMy WebLinkAbout041513_ca06Department of Public Works Consent Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Philip Morley, County Administrator From: Frank Gifford, Public Works Director ~~• Agenda Date: April 15, 2013 Subject: Execution of Contract with Western Industrial, Inc. Queets Bridge Painting Project, M.P. 0.60 to M. P. 0.76 Clearwater Road, Co. Rd. No. 107508, CR1881, Federal Aid Project No. BHOS-16WA(001) Statement of Issue: The issue is requesting execution of the Contract document for the Queets Bridge Painting Project, CR1881 with Western Industrial, Inc. for the bid amount of ($1,856,000). Analysis/Statestic Goals/Pros ft Cons: This project is included in the officially adopted 2012-2017 Transportation Improvement Program as Item No. 13. This project is also included in the adopted 2012 Annual Construction Program as item No. 13. The purpose of this project is to repaint the steel girders and bracing members of the Queets River Bridge. Bids for this project were obtained using the standard bidding process. The lowest responsive bidder was Western Industrial, Inc. of Mukilteo, WA. The Contract now needs to be executed for this project to proceed. Fiscal Impact/Cost Benefit Analvsis: This project is funded at 100% by the Federal Highway Administration, with a grant amount of $2,969,652.00. Recommendation: Public Works recommends that the Board execute all three (3) originals of the contract with Western Industrial, Inc. and return two (2) originals to Public Works for further processing. Department Contact: John Wayand, Project Manager, 385-9377 Revie e _ ilip Morliey;~ounty Administrator CONTRACT JEFFERSON COUNTY, WASHINGTON THIS AGREEMENT, made and entered into this 15th day of April, 2013, between the COiJNTY 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 Western Industrial, Inc. of Mukilteo, WA. 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 the Queets River Bridge - 8W, M.P. 0.60 to M.P. 0.76 Clearwater Road in West Jefferson County, Washington. The work includes cleaning, removal of existing lead paint, and painting the metal surfaces of the following: Bridge Plate Girders, End Diaphragm and Pier Cross Frames, Intermediate Cross Frames, Bottom Lateral Braces, All Transverse and Longitudinal Stiffener Plates, Added Girder Web Stiffeners, Girder Bolted Splices, and All exposed portions of each Bridge Bearing and other work, all in accordance with the Contract Provisions and Standard Specifications. for the total sum of One Million Eight Hundred Fi Six dollars ($1,856,000.00) 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 daX following the Notice to Proceed Date. Be inning with the first working_dav the project shall be nhysically complete within 105 working dam 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: VII. 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. Page 1 of 7 Revised 10/30/12 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. 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(1) - 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 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 Page 2 of 7 Revised 10/30/12 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, WA. The Contractor shall indemnify 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 indemnify 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 of R.C.W. 4.24.115 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. 8. The Contractor shall 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. Page 3 of 7 Revised 10/30/12 Attachments hereto, incorporated by reference: • Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion; and • Contract Bond Page 4 of 7 Revised 10/30/12 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 ~~a1~~-~ ~~, 2013 Contractor: (Please print) State of Washington, Contractor Registration Number COUNTY OF JEFFERSON BOARD OF COMMISSIONERS John Austin, Phil Johnson, David W. Sullivan, Ap oved as to form nly: a~ 9 13 David Alvarez Date Deputy Prosecuting Attorney ~~•-~ Y18~l3 Frank Gifford Date Public Works Director Page 5 of 7 Revised 10/30/12 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, 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 debarment, 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 against 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 enumerated in paragraph (2) of this certification; and (4) Have not within a 3-year period preceding this contract had one or more public transactions (Federal, 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. Name of Contractor (Please print) 'MA2K ~A~KSC~N Name and Title of Authorized Repre~a"Irntative (Please print) Signature of Authorize ~~!DLIS~~`If~~, ANC ~LSCD~~r I am unable to certify to the above statement. An explanation is attached. Page 6 of 7 Revised 10/30/12 Bond #: D00000011 CONTRACT BOND JEFFERSON COUNTY, WASHINGTON KNOW ALL MEN BY THESE PRESENTS: That Western Industrial, Inc. ~ of Mukilteo, Washington , as Principal, and Darwin National Assurance Company as Surety, are jointly and severally held and bound unto the COUNTY OF JEFFERSON, the penal sum of One Million Eight Hundred Fifty Six Thousand & no/t00ths Dollars ($ 1,856,000.00 for the payment of which we jointly and severally bind ourselves, or heirs, executors, administrators, and assigns, and successors and assigns, firmly by these presents. The condition of this bond is such that WHEREAS, on the (~ day of APRIL , A.D., 2013_, the said Western Industrial, Inc. ,Principal herein, executed a certain contract with the County of Jefferson, by the terms, conditions and provisions of which contract the said Western Industrial, Inc. ,Principal herewith, agrees to furnish atl materials and do certain work, to-wit: That the said Principal herein will undertake and complete the following described work: Queets River Bridge Painting Proiect, M.P. 0.60 to M P 0 76 Clearwater Road County Road Project CR1881 County Road No. 107508 in Jefferson County, Washington, as per maps, plans and specifications made a part of said contract, which contract as so executed, is hereunto attached, and is now referred to and by this reference is incorporated herein and made a part hereof as full for all purposes as if here set forth at length. NOW THEREFORE, if the Principal herein shall faithfully and truly observe and comply with the terms, conditions and provisions of said contract, in all respects and shall well and truly and fully do and perform all matters and things by the said Principal undertaken to be performed under said contract, upon the terms proposed therein, and within the time prescribed therein, and until the same is accepted, and shall pay all laborers, mechanics, subcontractors and materialmen, and all persons who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work, and shall in all respects faithfully perform said contract according to law, then this obligation to be void, otherwise to remain in full force and effect. WITNESS our hands this stn day of April , 2013. Western Industrial, Inc. Darwin National Assurance Company PRINCIP SURETY COMPANY By: r ~ CUC~l.L B ~~ Y Mark Jackson, President /~q J / /' ~ `J Jason Hale Attorne -in-fact Address of local office and agent of surety company: Propel Insurance 1201 Pacific Avenue, Suite 1000 Tacoma. WA 98402 Page 7 of 7 Revised 10/30/12 .. ~ .;- - DARWIN NATIONAL ASSURANCE COMPANY 30 S.17~ St., Suite 810, Philadelphia,'PA 19103 POWER OF ATTOR~tEY No. 37 KNOW ALL MEN BY THESE PRESENTS: Darwin National Assurance Company, a Delaware corporation (the "Company")does hereby appoint NAME(s): Robert E. Staples -Jason Hale °Timothy iviafliore FIRM: Allied World NationaLAssurance Company OFFICE t.OCATION: 30 South 17~,Street, Suite 810 United Plaza, Philadelphia, PA 191.03 Ifs true and lawful Attorneys)-in-Fact, with full authorityto exe~,utc nn its behalf bonds, undertakings, recognizances and other contracts of indemnity end viritings obligatory in the nature thereof, issued in the course of its business, and to bind the Company thereby. IN WITNESS WHEREOF, rrDARW1N NATIONAL ASSURANCE COMPANY has caused these presents to be executed by the officer named below; whois duty authorized and empowered to execute on the Company's behalf. This 5th day of A~ri1~ 2013 ~ p - - - ~ ~~ ,~, me: R ~ .' Staples,. ' ~:~~,'~P~dldl: tic: Senior ~rce President ' State of Pennsylvania ) Phila. Cot~rly County of Philadelphia )ss. I~~rernber 18,:2094 On ti 5 nth day of " ril, 209 J, beiure me came the above-nan Feu Mfr ~ci ~ ~ C~ ~ Tv'v'lid /} t~:?,TiO .~,L ~.SSURANCE COPJ~PAMf, to me personally'~nown to be ii~e iridi.i iu~l and 1 ~~r~ ~ ~, ~ ~, r f'.c~r described herein, and acknowledged that he executed the forego ~Lrg'nstrument and Notary: Michae W. Zahodski attixed the seals of said corporation thereto by authority,of his off ce. i My Commission Expires: 11-18-2014 CERTIFICATE Excerpt of Resolution adopted 6ythe Board of Directors'of the DARWIN NATIONAL INSURANCE'GOMPANY, on December, ?r11 ~: "RESOLVED, that the. President, or any Vice President!be, and'°hereby is; authorized to appointAttomeys-in Fact to represent and act for and on beftatf of Uae Company',to execute bonds, undertakings, recognizances and other contracts of indemrifty and writings obligatory in the nature thereof, and to attach thereto the corporate seal of-the- Company, in the transaction of its surety business; 'RESOLVED, fhat the ignatures and attestations of such officers and the seal'of the Company may be affixed to any suci~ Power of Attomey or to any certificate relating thereto by facsimile, grid any such Power of Attorney or certificate bearing'such facsimile signatures ar'fiacsimile seal shall be valid and birtling [ipon the Company when so affixed with respect to any bond, undertaking, recognizance or other contract of indemnity or writing obligatory in the nature thereof; ' RESOLVED, that thefacslmile ~r mechanically reproduced signature of the Secretary of the Company, whether made heretofore or hereafter,wherever',appearing upon a copy of any Powerbf Attorney of the Company; with signatures affixed'as next above noted, shall 6e valid and binding upon the Company with the same force and effect as though ' manually affixed.' "RESOLVED, that any such Attomey-in-Fact delivering. a secretarial certification that :ire f~~~e;~oing resolutions still be in effect may insert in such certification the date thereof, said date to be not laterthan #hedate of elivery thereofliy such Attomey-in-Fact." 1, TIMOTHY J. CURRY; Secretary of the DARWIN NATIONAL INSURANCE COMPANY, tlo hereby c~rrify that the foregoing excerpts of Resolution adopted by the Board of Directors of this corporation, and the PowerofAttomey issued pursuanttt r,;` ~, are true and correct, and that both the R..=cl tion and the PowerofAttomey are in full force and effect. IN WITNESS WHEREOF;! have hereunto set my hand and affixed the fac., r,, .; seat of the w,T:; ,.~.,. ,, ti, is 5th day Of April, 2013 ...Secretary: t~~~ / SUR 00007 00 (11!2012) - DARINiN NATIONAL ASSURANCE COMPANY - NAIC # 16624 CONDENSED STATUTORY BASIS FINANCIAL STATEMENT ADMITTED ASSETS BONDS COMMON STOCKS INVESTMENT tN SUBSIDIARIES GASH & StiORTTERM INVESTEMENTS AGENTS BALANCES OR UNCOLLECTED PREMIUMS OTHER ASSETS TOTAL ASSETS LIABIl.tT1ES RESERVE FOR LOSSES RESERVE FOR LOSS ADJUSTMENT EXPENSES RESERVE FOR UNEARNED'PREMtUMS ALLOTHE'R LIABILITIES TOTAL LIABILITIES AS OF DECEMBER 31, 2011 476,972,955 3.8,580,097 60,572,854 27,107,245 23,929,002 .40,721,448 $ 667,883,601 143,457,933 72,123,563. 25,104,868 83,980,750 324,667,114 CAPITAL AND SURPLUS SPECIAL SURPLUS FUNDS CAPITAL STOCK CAPITAL IN EXCESS OF PAR VALUE UNASSIGNED SURPLUS TOTAL CAPITAL AND SURPLUS TOTAL 343,216,487 $ 667,883,601 In the state of New York, county of New York, Robert Larson `~-V personally appeared before the undersigned who being duly sworn, deposes an say that he is the Vice President and Treasurer of Darwin National Assurance Company and that the foregoin atement is correct and true. .NOTARY Sworn to and Subscrt e~ #ore Me this /~ day of January, 2013 Signature ~`'~<~- My Commission Expires / MURZENA LEUNG Notary Pubfic, State of New York 91LE615~740 Qualified in Queens County Commission Expires Sept. 18, 20 1,230,639 3,500,000 180,282,056 158,203,792 259845 AC'o;I~Z©`~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kate Noonan NAME: Y Commercial Lines - (206) 892-9200 aC NNo Ext : 206-892-9249 aC No ; 206-892-9201 Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 E-MAIL kath n.a.noonan wellsfar o.com ADDRESS: ry @ g 601 Union Street, Suite 1300 INSURERS AFFORDING COVERAGE NAIC # Seattle, WA 98101-1371 INSURERA: Travelers Property Casualty Co of America 25674 INSURED INSURER B ; American Longshore Mutual Assoc Western Industrial, Inc. INSURER c : Evanston Insurance Company 35378 11709 Cyrus Way INSURER D INSURER E Mukilteo WA 98275 INSURER F COVERAGES CERTIFICATE NUM6ER_ StSytiU;Sti RFVISIAN NIIMRFR• coo hnln~u 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. I TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDY/YYYY MM/DDY/YYYY LIMITS A GENERAL LIABILITY 14R61213 05/25/2012 05/25/2013 EP`CH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 CLAIMS-MADE ~ OCCUR MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 X POLICY PRO LOC SRLL $ 1,000,000 /.~ AUT OMOBILE LIABILITY BA9A980998 05/25/2012 05/25/2013 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per accident ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- B AND EMPLOYERS' LIABILITY ALMA00717-02 05/25/2012 05/25/2013 IT ~, / N ANY PROPRIETOR/PARTNER/EXECUTIVE ~ N / A E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 $ A Stop Gap Liability 14R61213 05/25/2012 05/25/2013 $1,000,000 ea acc Includes WA, WY, $1,000,000 dis. pol lim OH, ND $1,000,000 dis. ea empl DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 107, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured on the general liability, pollution and auto liability with respect to work performed by the named insured under contract. GL policy includes Ship Repairer's Legal Liability coverage of $1,000,000. 30 day notice of cancellation applies except 10 days for non-payment of premium. CERTIFICATE HOLDER CANCELLATION County of Jefferson SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 621 Sheridan St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Port Townsend, WA 98368 AUTHORIZED REPRESENTATIVE /'~ ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved. .!This rxtifirate renkner rnrtifiratWt.57d47fii ics,wA nn 3H5/20137 CID: 259845 SID: 5896036 I Certificate cif Insurance (Can't ~ OTHER Coverage INSR TYPE OF INSURANCE ADDL VWD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMIT LTR INSR SUBR (MMIDDIYY) (MM/DDIYY) C Project Pollution Liability X 2789804 02/04/2013 02/04/2014 1,000,000 N W Q 0 o COPY BLANKET ADDITIONAL INSURED ENDORSEMENT - INCLUDING CpMPLETED OPERATIpNS (BROAD FARM) N O O `- In consideration of an additional premium of $included and subject to all terms, S conditions and exclusions contained in this policy, and further subject to the conditions of ., this endorsement, it is agreed that: °0 1. Claus 11 -Persons Insured of Section I: General Conditions is amended to include as an additional insured, with waiver of subrogation if required, any person or ~ organization whom the Named Insured is required to add as an additional insured on this policy under: v N {1) A written contract; or ~ (2) An oral agreement or contract where a Certificate of Insurance has been issued showing that person or organization as an additional insured; but the r oral agreement or written contract must be: c (a) An "insured contract"; N O o {b) Currently in effect or becoming effective during the term of this policy; ~ and ar (c) Executed or agreed to prior to an "occurrence" or offense that gives rise to a "claim" or "suit". Such person or organization is an additional insured only with respect to liability arising out of work performed for said additional insured by or on behalf of the Named Insured. When required by a written contract or agreement between the Named Insured and the additional insured, shown on a Certificate of Insurance provided to this Company, coverage afforded by this policy shall be primary and non-contributory. 2. Where a contract or agreement for the lease or rental of premises obligates the ~ Named Insured to add the manager or lessor of such premises as an additional insured, such manager or lessor is an additional insured only with respect to their liability arising out of the maintenance, operation or use by the Named Insured of i~ that leased premises. ~~ This insurance does not apply to: {a) Any "occurrence" which takes place after the Named Insured has ceased i to lease or rent the premises; (b) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured; ~- (c) Liability arising out of the sole omission or negligence of the additional a~ insured. 3. Where a contract or agreement for the lease or rental of equipment obligates the Named Insured to add the lessor of such equipment as an additiona! insured, such Name of Insured Policy Number zoL-14R61213-12-Nn Effective Date 11/01/12 WESTERN INBC3STRIAL, INC. Processing Date 11/20/12 12:55 002 OMOL013$ Ed. 7-05 ~ 2005 The Travelers Indemnity Company. All rights reserved, Page 1 of 2