HomeMy WebLinkAbout061713_ca02Department of Public Works
Consent Agenda
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Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Philip Morley, County Administrator
From: Frank Gifford, Public Works Director ~~
Agenda Date: June 17, 2013
Subject: Execution of Construction Contract
Larry Scott Trail, Project No. CR1069
County Road No. 860100
Statement of Issue:
The issue is requesting execution of the Contract with C It J Excavating Inc of Carlsborg in
the amount of $31,672.00. The scope of work for this project is the construction of an
equestrian parking area at the Milo Curry Trailhead of the Larry Scott Trail. This project
has been bid in accordance with the Small Works Roster bidding procedures for the project
referenced above.
Analysis/Strategic Goals/Pro's 8 Con's:
This project is item number six on the 2013-2018 Six Year Transportation Improvement
Program and is included in the 2013 Annual Construction program.
Fiscal Impact/Cost Benefit Analysis:
The Recreation and Conservation Office (RCO) will fund 50% of project costs to match local
funds.
Recommendation:
The Board is asked to sign the three original copies where indicated, and return two signed
copies to Public Works (attn Valerie Greene).
Department Contact:
Valerie Greene, Project Manager 385-9189
Reviewed By:
~ ~~ Philip Morley, Cou ty Ad inistrator X3.0 ~ Date
CONTRACT
JEFFERSON COUNTY, WASHINGTON
THIS AGREEMENT, made and entered into this day of , 2013, between the COUNTY OF
JEFFERSON, acting through the Jefferson County Commissioners and the Director of Public Works under and by virtue
of Title 36, RC W, as amended and ~- E ~ of C~r\ bo r~ ~c: ~
hereinafter cal d the Contractor.
WITNESSETH:
That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the
parties hereto covenant and agree as follows:
1. The Contractor agrees to furnish all labor and equipment and do certain work, to-wit: That the Contractor herein
wit] undertake and complete the following described work:
LARRY SCOTT MEMORIAL TRAIL
Mila Curry Trailhead Parking
County Road Project No. CR1069
County Road No. 860100
for the total sum of thirty one thousand, six hundred seventy two dollars and zero cents dollars ($ 31,672.00) 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: within a specified amount of time after the Notice
to Proceed.
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 Tess 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 I or9
Revised IOI30/12
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 aze 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.
AI] 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(]) - 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.
(])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
Pege 2 of 9
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.
[t 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 ofthe 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.
Page 3 of 9
Revised 10/30/12
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.
For contracts of $35,000 or less, the County and the Contractor may agree that in-lieu of the Bond; the County
will withhold 50% of the Contract amount in accordance with RCW 39.08.010. The Contractor will indicate this option
on Exhibit A.
The Contractor will declare management option of the statutory retained percentage on Exhibit B.
Page 4 of 9
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 Ee , 2013
Contractor:
~ ~~ (~xcn ua~r~a T nc
(Please print]
By: Gur~l L. Scar e:~d~er
~~nn (Pleas rintJ J ~~ ~
(Signature
C~cxCz~ogaPC
State of Washington, Contractor Registration Number
COUNTY OF JEFFERSON
BOARD OF COMMISSIONERS
John Austin, Chair
Phil Johnson, Member
David W. Sullivan, Member
roved as to for only:
z~,q 13
David Alvarez Date
Deputy Prosecuting Attorney
Frank Gifford Date
Public Works Director
Page 5 of 9
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 civiljudgment 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.
~(- ~ ~KC0.tTc~ i Y~Pl~ = hL
Name of Contractor (Please print)
~- ScG.r.etc~er' Presic~e~n'E-
I am unable to certify to the above statement. An explanation is attached.
Page 6 of 9
Revised 10/30!12
Name and Title of Authorized Representative (Please print)
1 of 3 Originals
CONTRACTBpND
JEFFERSON COUNTY, WASHINGTON
Bond No. 105 939 845
KNOW ALL MEN BY THESE PRESENTS:
That C & J IStcava~
Travelers Cas ty an ure~
(Yra~nv of Arrpr].Ca
JEFFERSON, lire penal sum of
far the payment of which we jou
-; *~g r Inc • - o f Carlsl~org, LdA es Principal, and
Y
_~ as Surety, are jointly and several~t ~ed lpund unto the COUNTY OF
Thirty one thousands ~
~~>or,+v +wn s. nnJtnnthG Dollars (531,672.00 ),
ttly 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 , A.D, 2013; the said
C & J F~tcavating, Inc. Principal herein, executed a certain contrnct with the County of Jefferson, by the
terms, conditions and provisions of which contract the said C & J >~ccavating, Inc. principal herewith, agrees
to furnish all materials and do certain work, to-wit: That the said Principal herein will undertake and complete the following
described work: LARRY SCOTT MEMORIAL. TRAIL PROJECT, MILD CURRY TRAlZHEAD PARKrivG,
COUNTX ROAb PROJECT NO. CR1069, COUN'T'Y ROAR N0.860100,
in Jefferson County, Washington, as per maps, plans and specifications made a part of said contract, which contract as so
executed, is hereurrto attached, end is now referred to and by this referenrs is incorporated herein and made a part hereof as
full for sll purposes as if here set forth at length.
NOW THE.REPORE, if the Principal herein shall faithfirlly and tntly observe and comply with the terms, conditions
and provisions of said contract, in all respects and shall well and truly end fully do and perform ali matters and things by the
said Principal undertaken to ire perfrnmed 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, end
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 contraet according to Taw, then this obligation to be void, otherwise to remain
in full foroe and effect.
WfIT1ESS our luurds this 5~ day of June , 2013.
C & J Exrravati.ng, Inc.
PRINC]PAL ~
Travelers Casualty and S~uj~rety Company of America
SURETYC0~91•
By: _~s
By: Chris A. Fix
Attorney-in-fact
Address of loved ofT'ice and agent
of surety company;
c% CB&MS of I^7A. INC.
_PO Box 75715
Goat+le. l~ 98175
Page 7 of9
Revived 10!30/!2
~A. POWER OF ATTORNEY
TRAVELERS J Farmington Casnal[y Company St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc Travelers Casualty and Surety Company of America
S[. Paul Fire and Marine Insurance Company United Stales Fidelity and Guaranty Company
SL Paul Guardian Insurance Company
Attorney-In Fart Nn. 221140 Gertifirate Nn. 0 0 5 3 2 7 4 5 0
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Pire and Mazine Insurance Company, St. Paul Guadian Insurance
Company, SL Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United Stales
Fidelity and Guaranty Company are corporations duly organized under [he laws of the State of Connecticut, [ha[ Fidelity and Guazanry Insurance Company is a
corporation duly organized under the laws of the State of lows, and thn[ Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under [he
laws of the Smte of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, cons[imte and appoint
Christine V. Felicetty, N. B. Fix, R. A. Fix, Myung S. Fix, and Chris A. Fix
of the City of Seattle ,State of WaS17iI1°tOtt ,their true and lawful Attorney(s)-in-Fact,
each in [heir separate capacity if more than one is named nbove, to sign, execute, seal and acknowledge any and al] bonds, recogniznnces, conditional undertakings and
other writings obligatory in [he nature [hereof on behalf of the Companies in their busjness of_guaranteein€ the fideliTy of persons, o amnteeing the performance of
contracts and executing or guaranteeing bonds and undertakings requited oe pemutfzdtin an} aatons ox prFlceedingys allowed by law.
M,
t*4
IN WITNESS WHEREOF, the Companies have caused this mstmment to be signed and then corporate seals to be hereto affixed, this
aaY of January ?013
Farmington Casualty Compapy
Fidelity and Guaranty `Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
S[. Paul Guazdian Insurance Company
10th
St. Paul Merwry Insurance Company
Travelers Casualty and SureTy Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
6V ~p"r,-~~ y I
`N ar i ~ y ~f L O~lX _ NSV9 ,p\ ,~xs4q~ 9 a~ 'Wp ap{IpWY Y~•
~' 6 n g i$1 ~lcoP>a q,em ry i~ppPON9IY..,nt ~.%
1681983 o i 1977 ~ < 1 ~: - ~ : ._ ;^ wnrrono. ~/rn/m~w,~,ro~]~ a ~t mrm
v
i "rtc~a^ ~ d~~ ~8'J7 y~ ~sSE AL%o'f Y ~sSBAL:'~ ~O~ ~,"'"`/~Y u~ 8967
s .....~ ~... i as r
•y . nH ~c.. iY ~. r~ r ...~..'r"a F ANt
State of Connecticut
Ci[v of Hartford ss.
By:
Robert L. Raney, enior Vice President
On this the 10th da} of January 2013 before me personally appeared Robert L. Raney, who acknowledged himself to
be [he Senior Vice Resident of Farmington Casualty Company, Fidelity and GuazanTy Insurance Company, Fidelity and Guazanty Insurance Underwriters, Inc., SL Paul
Fire and Marine Insucnncc Company, SL Paul Guardian Insurance Company, St. Paul Memory insurance Company, Travelers Casualty and Surety Company, Travelers
Casualty and Surety Company of America, and United Sm[es Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing
instrument far the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official .teal. ~G'T~
My Commission expires the 30th day of June, 2016. P ~LI~S
Marie C. Yetreault, Notary Public
58440-8-12 Printed in U.S.A.
This Power of Attorney is granted under and by the authority of the fallowing resolutions adopted by the Boards of Directors of Farmingon Casualty Company. Fidelity
and Guarauty Insurance Company, Fidelity and Guazanty Insurance Underwriters, Inc., St. Paul Aire and Mazine Insurance Company, SL Paul Guardian lnsumnce
Company, SL Paul Mercury Insurance Company, Travelers Casualty and SureTy Company, Travelers Casualty and Surety Company of America, and Uuited States
Fidelity and Guaranty Company, which resolutions aze now in full force and effect, reading as follows:
RESOLVED, that the Chairman, [he Presideut, any Vice Chairman, any Executive Vice President, any Seuior Vice President, any Vice President, any Second Vice
President, the Measurer, any Assismnt Measurer, the Corpomte Secretazy or any Assismnt 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 xnd seal with [he
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 [he Boazd 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 Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vine Resident may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each each delegation is in writing and a copy
[hereof is fded in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the namee oP a bond, recognisance, or conditional undertaking
shall be valid xnd binding upon the Company when (x) signed by the Resident, any Vice Chairman, any Executive Vice President, auy Senior Vice Resident or any Vice
President, any Second Vice President, the Messmer, any Assistant Measurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secmmry or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant m the power
prescribed in his or her certificate oe their certificates of authority or by one or more Company officers pursuant m a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice Resident, any Vice President,
any Assismnt Vice President, any Secreary, any Assistant Secretmy, and the seal of the Company may be affixed by facsimm7e to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secremries or Attorneys-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 brazing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so exewted and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the fume with respect to any bond or understanding [o which it is attached.
I, Kevin E. Hughes. the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guazanty Insurance Company, Fidelity and Guazanty Insurance
Underwriters, loc., St. Paul Fire and Mazine Insurance Company, SL Paul Gumdiau Insurance Company, SL Paul Mercury Insurance Company, Travelers Casualty and
Surety Company, Travelers Casualty and Surety Company of America, and United Smre_s Fidel;t~~and Guaranty Company do hereby cerdfv that the above and foregoing
is a tme and correct copy of the Power of Attorney executed by said Companies, which<is m full foroe and effect and has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed theseals of said Companies this 5~1 day of JOE' 2013
~n E Hughes~istan[ Sec tar%
Nsu rr o` ~"" _i
p w4r fT~ Yev,e~~~.~ P~'v~oP~`i Jc"P~ ~x.T A~~ ~w~ ` IkUSWMy .y'Fa._ A't~
i~i983 0 ~ 1977 :; ;~ ~P uvrtrono, a tt+mwm, 4 ~m
g~~,t '~ ~~ 1951 ~P~.` ~.SE0.LJof j,SBAL;'~ C0N"P 9° ~~ gO
6 y . nPa S ~° ~ 15 .. A~~ P19 ~P ~ P f ' ft ~1~ ~Itt
To verify [he authenticity of this Power of Attorney, call 1-800-42 13 8 8 0 or conmc[ us at www.travelersbond.com. Please refer to the Attorney-In-Fact number, the
above-named individuals and the details of the bond to which [he power is attached.
EXHIBIT A
CONTRACTOR'S DECLARATION OF OPTION FOR CONTRACTS FOR LESS THAN $35,000
A. A Contract Bond will be provided as required.
Date ~e ~ 3 Signed ~ "~~ ~/~ ~~~ .=
B. In lieu of providing a Contract Bond, the County will withhold 50% of the Contract amount.
Date Signed
Page 8 of 9
Revised 10/30/12
EXHIBIT B
CONTRACTOR'S DECLARATION OF OPTION FOR MANAGEMENT OF
STATUTORY RETAINED PERCENTAGE
A. I hereby elect to have the retained percentage of this contract held in a fund by the Owner until (30) days
following final acceptance of the work.
Date Signed ~7 i ~~z
B. 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
C. 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.
1 hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of placing said retained
percentage in escrow and investing it as authorized by statute. The Owner shall not be liable in any way for any costs or
fees in connection therewith.
Date
Signed
Page 9 of 9
Revised 10/30112
C6JtA-l UY IU: Mtl\
'`'"'~°''~° C_E_RT_IFICATE t~F LIABILITY INSURANCE DATEwragmrnrl
~,~- 06!29/2013
THIS CERTIFICATE i5 ISSUED A9 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMA7IVELV OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED @Y 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 eerdOCate holder fa an ADDITIONAL INSURED, the poiley(lea) must be endorsed. If SU@RDGATION IS WAIVED, subject to
CNe Corms antl conditions of the poilcy, cenaln policies may requke an endorsement. A statement on thta csnificate doss not comer rights to the
PRODUCfiR phone: 360-583-3355 `NAMe""' Melanie Ross ,
ISG-5Dquim Fax: 425.649-9225 wpHON° 3$0-G83.3355 PAx
Insurance SSrvioes Group D, no, sKO, _ {Arc, Nup 369-683-9998
PO Box 2077 n,pn~ess; molanier~insuranceaervicosgroup com ,
Sequim, WA 88382 ...._
Travor3 Campbell ,, INSUaeRISIAPFGnoING COVERAgE Nglcq,..
INSURSRA American Fira and Casualty. Co,
__
iNauRED C & J Exoavating, Inc. IwaupERS. ....._ _ '..
PO Box 430 INSURERC
Carlsborg,WA98324
INaURfiR D:
INBUPER E
COVERAGE8 CERTIFICATE NUM@Eft: REVI61oNNUmtteR:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIGY PERIOD
INDICATED. NOTWiTMSTAN0INC ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT RR OTHER DOCUMENT WITH RESPECT 70 WHICH PHIS
CERTIFICATE MAV BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCIASIONS AND GONDfTIONS OF SUCH POLICIES. LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS .
INSh _... t0.bbL EUaN' _.. ._.. PGUCYEfp~. PdLICY E%P
LTA-_^,_ TYP60FIN8URANCE ~'I RYND POLICr NUMBER ~J(.],Idlbp/YYYY1'IMMII#1IYYYYI LIMIi_$. ...._...
___
,GENERAL LU1aR.ITY '., EACH gGtDRRENCE S 1,@99,@9
A X'.. CgMMEROIAL GENERALLWBILYrY X ~..,,@KAi453B51991 01 /91121113 i.,. B1i91J2914 DAMAGE YC?nENTpD
PREMISES {Fa i>ceur bncdY ,$
1,09D,99
'.,, CLAIMS-MADE X I DGCUR : , MEO E%P{MY and Pardor0 . 8 16,99
..
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" i ( : '., PERSONALa AGV INJURY $ 1,9D9~99
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OHECWP110N OF OPErU170NElL0CATION9/VENIGLfiB (AnRVh ACDRD 1b1, Adtliflonal RbntYkd EaM1WUle,ttmmo apace fs pgWradl
CeztiPiCate Holder is Additicnal 2nsur®d as respects to general llablity
coverage. please see policy form CCSB10 (10/09) attached se respects to the
additional inauzed status. CertiEiat® Holder ie Additional Snaured as
respects to commercial auto -policy farm CA8610 (Q1/10) ea respects to
additional ineuzed status
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DELNERED IN
JOffersOn Ctlunty ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN: Valerie Greene -~°°--°°-
623 Sheridan Street AUINORZEO REPR@EENTATNfi
Port Townsend, WA 98368 T~'~(..`~e..4rirtiia. ~..,,~,
PJ 18Ba-2010 ACORO CORPORATION. All rtghts reSRrved.
ACORD 25 (2010/96y The ACORD name and logo are registered marks of ACORD