HomeMy WebLinkAbout032414_ca13Department of Public Works
O Consent Agenda
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Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Philip Morley, County Administrator
From: Monte Reinders, Public Works Director/16-
Agenda Date: March 24, 2014
Subject: Execution of Contract with Seton Construction, Inc. for
Snow Creek Road Culvert Replacement, Snow Creek Road MP 3.78,
County Project No. CR1899, FHWA Agreement No. DTFH70-1 1 -E-
00039
Statement of Issue: Execution of Contract with Seton Construction, Inc. of Port
Townsend, Washington for the Snow Creek Road Culvert Replacement, County Project
No. CR1899.
Analysis /Strategic Goals /Pro's Et Con's: This contract is for construction of a new, 24
ft. span, Precast Reinforced Concrete Three -Sided Structure at Snow Creek Road
milepost 3.78.
Fiscal Impact /Cost Benefit Analysis: The bid amount is $219,178.38. Construction
will be funded at 100% by the Federal Highway Administration.
Recommendation: Public Works recommends that the Board execute all three (3)
originals of the Contract with Seton Construction, Inc. and return two (2) originals to
Public Works for further processing.
Department Contact: Mark Thurston, P.E., Project Manager, 385 -9160.
Reviewed By:
�� rzounty "Adininistr�� ator Date
CONTRACT
JEFFERSON COUNTY, WASHINGTON
THIS 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 Scion Construction. Inc. of Port Townsend. Washin on
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:
This Contract provides for the improvement of Snow Creek Road by replacing two culverts at milepost 3.78 (Andrews
Creek) in East Jefferson County near Ouilcene, Washington Work includes furnishing and installing a new 24 ft span
precast. reinforced. 3 -sided concrete box culvert with precast footings and precast wing walls stream restoration
resurfaciniz, guardrails. site restoration and other work
for the total sum of Two hundred nineteen thousand one hundred sevemy eight dollars and thirty eight cents
($219,178.38) 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
following the Notice to Proceed Date. Beginning with the first working day, the project shall be physically complete
within 45 working 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: 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.
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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, 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(]) - 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:
Broad Form Property Damage with no employee exclusion;
Personal Injury Liability, including extended bodily injury;
Broad Form Contractual /Commercial Liability including completed operations (contractors only);
Premises - Operations Liability (M &C);
Independent Contractors and Subcontractors; and
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
affected shall protect both parties and be primary coverage for any and all losses covered by the above described
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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.
Any insurance coverage for third party liability claims provided to the County by a "Risk Pool" created pursuant
to Ch. 48.62 RCW shall be non - contributory with respect to any policy of insurance the Contractor must provide in order
to comply with this Agreement.
If the proof of insurance or certificate of coverage indicating the County is an "additional insured" to a policy
obtained by the Contractor refers to an endorsement (by number or name) but does not provide the full text of that
endorsement, then it shall be the obligation of the Contractor to obtain the full text of that endorsement and forward that
full text to the County within 30 days of the execution of this Agreement
The County may, upon the Contractor's failure to comply with all provisions of this contract relating to insurance,
withhold payment or compensation that would otherwise be due to the Contractor.
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
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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. 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.
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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 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 M n P t:0 11 , 2014
Contractor:
.3&-rOAJ
(Please print)
By: ?>euGe- 13. Sero" 7k.
(Please print)
Oe 'eq
(Signature)
Se: -rou CT IIoS OA
State of Washington, Contractor Registration Number
COUNTY OF JEFFERSON
BOARD OF COMMISSIONERS
John Austin, Chair
Phil Johnson, Member
David W. Sullivan, Member
Ap oved as to fo nly:
2 20l /`P
David Alvarez Date
Deputy Prosecuting Attom
n e Reinders, P.E. Date
Public Works Director /County Engineer
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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.
SE'rcljJ C &uS -17LvC- -rJ0.J
Name of Contractor (Please print)
Name and Title of Authorized Representative (Please print)
Signature of Authorize
❑ 1 am unable to certify to the above statement. An explanation is attached.
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CONTRACfBOND
JEFFERSON COUNTY, WASHINGTON Bond No 2178820
KNOW ALL MEN BY THESE PRESENTS:
That Seton Construction, Inc. of Port Townsend. WA , SS Principal, and
North American Specialty Insurance Company as Surety, are jointly and severally held and bound unto the COUNTY OF
JEFFERSON, the penal sum of Two hundred nineteen thousand one hundred seventy eight dollars and thirty eight cents
Dollars (S 219.178.38 )J or the payment of which wejointly 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 24th day of March , A.D., 201 4 , the said
Seton Construction, Inc. , Principal herein, executed a certain contract with the County of Jefferson, by the
terns, conditions and provisions of which contract the said Seton Construction, 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:
Snow Creek Road Culvert Replacement. Snow Creek Road MP 3.78 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 shalt 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 24th day of March 2014 .
Seton Construction, Inc.
PRINCIPAL
By. ,469mr�+4�jCL
North American Specialty Insurance Company
SURETY COMPANY
B -
By: Joanne Reinkensmeyer
Anomey -in -fact
Address of local office and agent
of surety company:
Hentschell & Associates. Inc.
621 Pacific Ave. Suite 400
Tacoma, WA 96402
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NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International
Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of
Schaumburg, Illinois, each does hereby make, constitute and appoint:
THOMAS P. HENTSCHELL, BRADLEY A. ROBERTS, JULIE A. CRAKER,
KAREN A. INGRAM, KAREN J. SMITH and JOANNE REINKENSMEYER
JOINTLY OR SEVERALLY
Its true and lawful Attomey(s )-in -Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: FUTY MILLION ($50.000.000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on the 9' of May, 2012:
"RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized 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 and 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 bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
a0wnn11111,
° :sa�cu!. ry /,kP', tawtt
b.0a1j:.. a ..
Tg A ? By FIi�RPOj
s U'' SIAI = Slevea P. Aatlerwa, Senior vice heaWml of Wuhlnrtoh loternatlond Inaunna Co.,.., YY SEAL P'
=y1 1073 !W'�n a SeMor Vke PrerldenlofNonh Amedun Speciln luunnne Cocn,, 6i
z
'ImnmuN\c`� F�
D By M. Nyman, vice PmWeel of Wuhingion Iotereario" Ineunnce Company 4 '
6 Vice Pm Went of Vonh Amen. Sp raft, luunnce Compuy
IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their
official seals to be hereunto affixed, and these presents to be signed by their authorized officers this20th day of June 2012 .
North American Specialty Insurance Company
Washington International Insurance Company
State of Illinois
County of Cook ss:
On this 20111 day of June 2012 before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman ,
Vice President of Washington International Insurance Company and Vice President 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 voluntary act and deed of their respective companies.
"ONNAALSFAL" �>Urtp ill. , n.0
DONNA D. SKLENS
Notary Publir.SdeofOliaoJ15 Donna D. Sklens, Notary Public
M r'anl_ IA
1, Jeffrey Goldberg .the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington
International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North
American Specialty Insurance Company and Washington International Insurance Company, which its still in full force and effect.
WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this °?? day of 120/1(.
lefrm7 Goldberg Vice Pruidml a Amount Seammy of
Wo.N.Smn Inrmnotionol Inru . Company a Nmth Ammon Spmirlty Inarraae C.,xtoy
ACORO' CERTIFICATE OF LIABILITY INSURANCE
0 YYY)
3/5/02'014
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: It 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
NAME: Trina Maher
Kuresman Insurance
PNONE (360) 692 -6131 FAX . (360)692 -6187
9321 Bayshore Dr. NW
I .trinam@kureamanins.com
ON
STE 111
INSURERS AFFORDING COVERAGE NAIC9
INSURERALiberty Northwest Insurance Co
Silverdale WA 98383 -8350
INSURED
INSURERS:
S 100,000
INSURERC:
X COMMERCIAL GENERAL LIABILITY
CLAIMS-WADE QOCCUR
Seton Construction, Inc.
INSURER D:
r1O 16 -16 -02
4640 Discovery Rd
INSURER E
MED EXP(Any one person)
$ 5,000
INSURER F:
S 1,000,000
Port Townsend WA 98368
COVERAGES CERTIFICATE NUMBERCL1310103100 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ITTR
L
TYPE OF INSURANCE
1=J=
POLICY NUMBER
EMWO CY EFF
M 1O YEXP
LIWTS
GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,000
PREMISES 46, occumimaa,)
S 100,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS-WADE QOCCUR
X
Y
r1O 16 -16 -02
0/30/2013
0/30/2014
MED EXP(Any one person)
$ 5,000
PERSONAL S ADV INJURY
S 1,000,000
X L7GGERa BROAD FORM
GENERAL AGGREGATE
S 2,000,000
GENL AGGREGATE
LIMIT APPLIES PER
PRODUCTS - COMNOP AGG
S 2,000,000
X POLICY
PRO LOC
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s
AUTOMOBILE
LABILITY
COMBINED 1 SINGLE LIMIT
Ma A
1,000,000
X
BODILY INJURY (Per person)
S
A
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
10 16 -16 -02
0/30/2013
0/30/2014
I
BODILY INJURY IPeradem)
m
S
X
NON -OWNED
HIRED AUTOS X AUTOS
PROPERTY DAMAGE
P acc,ar,t
$
Urbarm. Mmotonst
$ 11000,00
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
S 2,000,000
AGGREGATE
$
A
EXCESS UAB
CLAIMS -MADE
DIED I I RETENTIONS
S
F10 16 -16 -02
0/30/2013
0/30/2014
A
WORKERS COMPENSATION
NC STATLL
TO
AND EMPLOYERS' LIABILITY Y I N
PROPRIETCR PARTNER/ ECUTIVE
ANY AI
OFFICEREMBER EXCLUDED ❑
(MMSdsl ryIn NH)
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10 16 -16 -02
0/30/2017
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EL EACH ACCIDENT
s
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DESCRIPTION OF OPERATIONS NMoR
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10 16 -16 -02
0/30/2013
0130/2014
$1000 DEO $300,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IANach ACORD 101, Additional Remarks Schedule, H mom space Is "uIred)
CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED PER CG8416.
INSURANCE IS PRIMARY AND NON CONTRIBUTORY WITH WAIVER OF SUBROGATION PER CGB416.
RE: SNOW CREEK ROAD CULVERT REPLACEMENT
JEFFERSON COUNTY DEPARTMENT OF PUBLIC WOR
623 SHERIDAN STREET
PORT TOWNSEND, WA 98368
ACORD 25 [2010105)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Mabarry /MwM ?-Ir"Y
1968 -2010 ACORD CORPORATION All rinhta rpcarvad
INS025 neHmA, m TM Arnon mess ar,,4 berm xn eaani.t ... A, s,k. M &r -npII
COMMERCIAL GENERAL LIABILITY
CG 8416 12 03
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
GENERAL LIABILITY MASTER PAK PLUS(9)
FOR CONSTRUCTION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
TIFIM
Subject page
Blanket Additional Insured (Owners, Lessees or Contractors)
2
Fire, Lightning. Explosion and Sprinkler Leakage Damage to Premises You Rent
3
Non -Owned Watercraft
4
Supplementary Payments (Bail Bonds)
4
Personal And Advertising Injury - Electronic Publication Extension
5
Aggregate Limits (Per Location)
5
Aggregate Limits (Per Project)
5
Voluntary Property Damage Coverage
6
Off Premises Care, Custody or Control Coverage
6
Newly Formed or Acquired Organizations
7
Duties in the Event of Occurrence, Offense, Claim or Suit
7
Bodily Injury (Mental Anguish)
8
Waiver of Transfer of Rights of Recovery Against Others
8
Medical Payments 8
Broad Named Insured 8
Broadened Mobile Equipment 8
Incidental Malpractice Liability 8
Non -Owned Aircraft g
Property Damage - Elevators g
CG 8416 12 03 Includes copyrighted material of ISO Properties. Inc.. with its permission. Page 1 Of 9
E 600 00
1. BLANKET ADDITIONAL INSURED (Owners, Lessees Or Contractors)
(Includes a Primary/Non-Contributory provision)
Section II - Who Is An Insured is amended to include as an insured any person or organization whom
you are required to name as an additional insured on this policy in a written contract or written
agreement. The written contract or written agreement must be currently in effect or becoming effective
during the term of this policy and executed prior to the "bodily injury," "property damage" or "personal
and advertising injury."
The insurance provided the additional insured is limited as follows
A. The person or organization is only an additional insured with respect to liability:
Arising out of real property, as described in a written contract or written agreement, that you
own, rent, lease or occupy; or
2. Caused by your ongoing operations performed for the additional insured.
The insurance provided the additional insured in 1.A.2. above does not apply to:
a. Coverage A -Bodily Injury and Property Damage Liability, Coverage B -Personal and
Advertising Injury Liability or defense coverage under the Supplementary Payments
arising out of an architect's, engineers or surveyor's rendering of or failure to render any
professional services including:
(1) The preparing, approving, or failing to prepare or approve maps, shop drawings,
opinions, reports, surveys, field orders, change orders or drawings and specifications;
and
(2) Supervisory, inspection, architectural or engineering activities.
III "Bodily injury" or "property damage' occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work,
on the project (other than service, maintenance or repairs) that was performed by or on
behalf of the additional insured(s) at the site where the covered operations have been
completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or
subcontractor engaged in performing operations for a principal as part of the same
project.
B. The limits of insurance applicable to the additional insured are those specified in a written contract or
written agreement or the limits of Insurance as stated in the Declarations of this policy and defined in
Section III - Limits Of Insurance of this policy, whichever are less. These limits are inclusive of and
not in addition to the limits of insurance available under this policy.
C. The insurance provided the additional insured does not apply to the liability resulting from the sole
negligence of the additional insured.
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D. As respects the coverage provided to the additional insured under this endorsement. Section IV-
Conditions is amended as follows
1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim, or
Suit
An additional insured under this endorsement will as soon as practicable
a. Give written notice of an "occurrence" or an offense, that may result in a claim or "suit" under
this insurance to us,
b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have
insurance available to the additional insured, and
c. Agree to make available any other insurance which the additional insured has for a loss we
cover under this Coverage Part.
2. The following is added to Condition 3. Legal Action Against Us
We have no duty to defend or indemnify an additional insured under this endorsement until we
receive written notice of a claim or "suit" from the additional insured.
3. The following is added to Paragraph a., Primary Insurance of Condition 4. Other Insurance:
If the additional insured's policy has an Other Insurance provision making its policy excess, and
a Named Insured has agreed in a written contract or written agreement to provide the additional
insured coverage on a primary and noncontributory basis, this policy shall be primary and we will
not seek contribution from the additional insured's policy for damages we cover
4. The following is added to Paragraph b., Excess Insurance of Condition 4. Other Insurance
Except as provided in Paragraph 4.a. Primary Insurance as amended above, any coverage
provided hereunder shall be excess over any other valid and collectible insurance available to
the additional insured whether primary, excess. contingent or on any other basis. In the event an
additional insured has other coverage available for an "occurrence" by virtue of also being an
additional insured on other policies, this insurance is excess over those other policies
2. FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT
If Damage To Premises Rented To You under Coverage A is not otherwise excluded from this policy,
the following applies
A. The last paragraph of 2 Exclusions of Section I - Coverage A is replaced by the following
If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do
not apply to damage by fire. lightning. "explosion" or sprinkler leakage to premises while rented to
you or temporarily occupied by you with permission of the owner A separate limit of insurance
applies to this coverage as described in Section III - Limits Of Insurance.
B. Paragraph 6. of Section III - Limits Of Insurance is replaced by the following
6. Subject to 5. above, the higher of $300,000 or the Damage To Premises Rented To You Limit
shown in the Summary of Limits and Charges section of this policy is the most we will pay under
Coverage A for damages because of "property damage" to premises rented to you or
temporarily occupied by you with the permission of the owner arising out of any one fire.
lightning, "explosion" or sprinkler leakage incident.
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C. Paragraph b.(1)(b) of Condition 4. Other Insurance (Section IV — Conditions) is replaced by the
following:
(1) That is Fire, Lightning, Explosion or Sprinkler Leakage insurance for premises rented to you or
temporarily occupied by you with the permission of the owner,
D. Paragraph 9.a of the definition of "insured contract' in Section V- Definitions is replaced by the
following
9. "Insured contract' means
a. A contract for the lease of premises. However, that portion of the contract for a lease of
premises that indemnifies any person or organization for damages by fire, lightning,
"explosion" or sprinkler leakage to premises while rented to you or temporarily occupied by
you with the permission of the owner is not an "insured contract",
E. The following definition is added to Section V - Definitions
"Explosion" means a sudden release of expanding pressure accompanied by a noise, a bursting
forth of material and evidence of the scattering of debris to locations further than would have
resulted by gravity alone
"Explosion" does not include any of the following:
1. Artificially generated electrical current including electrical arcing that disturbs electrical devices,
appliances or wires,
2. Rupture or bursting of water pipes.
3. Explosion of steam boilers, steam pipes, steam engines or steam turbines owned or leased by
you, or operated under your control, or
4. Rupture or bursting caused by centrifugal force
3. NON -OWNED WATERCRAFT
Subparagraph g.(2) of Paragraph 2., Exclusions of Section I - Coverage A is replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than 51 feet long. and
(b) Not being used to carry persons or property for a charge,
4, SUPPLEMENTARY PAYMENTS
In the Supplementary Payments - Coverages A and B provision
The limit for the cost of bail bonds in Paragraph 1.1b. is changed from $250 to $1000.
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5. PERSONAL AND ADVERTISING INJURY -ELECTRONIC PUBLICATION EXTENSION
Paragraphs 14.b., d. and e. of Section V - Definitions are replaced by the following.
b. Malicious prosecution or abuse of process,
d. Oral, written, televised, videotaped or electronic publication of material that slanders or libels a
person or organization or disparages a person's or organization's goods, products or services,
e. Oral, written, televised, videotaped or electronic publication of material that violates a person's right
of privacy,
The following is added to Paragraph 14. "Personal and Advertising Injury" of Section V - Definitions
h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but
only if such discrimination or humiliation is:
(1) Not done intentionally by or at the direction of.
(a) An insured, or
(b) Any "executive officer" director, stockholder. partner or member of the insured, and
(2) Not directly or indirectly related to the employment, prospective employment or termination of
employment of any person or persons by any insured
Subparagraphs b and c. of 2., Exclusions of Section I - Coverage B - Personal And Advertising
Injury Liability are replaced by the following
b. Material Published With Knowledge Of Falsity
"Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic
publication of material, if done by or at the direction of the insured with knowledge of its falsity,
c. Material Published Prior To Policy Period
"Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic
publication of material whose first publication took place before the beginning of the policy period,
6. AGGREGATE LIMITS OF INSURANCE (PER LOCATION)
The General Aggregate Limit under Section III Limits Of Insurance applies separately to each of your
"locations" owned by or rented to you or temporarily occupied by you with the permission of the owner.
"Location" means premises involving the same or connecting lots, or premises whose connection is
interrupted only by a street, roadway, waterway or right-of-way of a railroad
7. AGGREGATE LIMITS OF INSURANCE (PER PROJECT)
The General Aggregate Limit under Section 111 Limits Of Insurance applies separately to each of your
projects away from premises owned by or rented to you
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8. VOLUNTARY PROPERTY DAMAGE COVERAGE
At your request, we will pay for "loss' to property of others caused by your business operations. The
most we will pay for this coverage is $500 each "occurrence." The 'loss" must occur during the policy
period. The "occurrence" must take place in the "coverage territory".
"Loss" means unintended damage or destruction. "Loss' does not mean disappearance, abstraction or
theft.
This coverage does not apply to:
1. Damage arising out of the use of any "auto ";
2. Property you own, occupy, rent or lease from others; or
3. Property on your premises for sale, service, repair or storage.
None of the other policy exclusions apply to this coverage.
If the policy to which this endorsement is attached is written with a property damage liability deductible,
the deductible shall apply to Voluntary Property Damage. The limit of coverage stated above shall not
be reduced by the amount of this deductible.
9. OFF PREMISES CARE, CUSTODY OR CONTROL COVERAGE
A. We will pay those sums that you become legally obligated to pay as damages because of "property
damage" to personal property of others while in your or your "employees' care, custody or control or
real property of others over which you or your "employees' are exercising physical control if the
"property damage" arises out of your business operations. This Coverage is subject to sections B.,
C., D. and E. below.
B. Exclusions
This insurance shall not apply to:
1. 'Property damage" of property at premises owned, rented, leased, operated or used by you;
2. "Property damage" of property while in transit;
3. The cost of repairing or replacing:
(a) Any of your work defectively or incorrectly done by you or by others on your behalf; or
(b) Any product manufactured, sold or supplied by you, unless the "property damage" is caused
directly by you after delivery of the product or completion of the work and resulting from a
subsequent undertaking: or
4. 'Property damage" of property caused by or arising out of the "products- completed
operations hazard ".
C. Limits Of Insurance - The most we will pay for "property damage' under this Section 9. is $25,000
for each "occurrence ". The most we will pay for the sum of all damages covered under this Section
9. because of "property damage' is an annual aggregate limit of $25,000.
The Limits Of Insurance provided under this Section 9. are inclusive of and not in addition to any
other limits provided in the policy or endorsements attached to it.
D. Deductible - We will not pay for "property damage' in any one "occurrence" until the amount of
'property damage' exceeds $250. If the policy to which this endorsement is attached contains a
'property damage' deductible, that deductible shall apply if it is greater than $250.
E. In the event of "property damage' covered by this endorsement, you shall, if requested by us,
replace the property or furnish the labor and materials necessary for repairs thereto at your actual
cost, excluding profit or overhead charges.
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10. NEWLY FORMED OR ACQUIRED ORGANIZATIONS
A. Paragraph 4. of Section II - Who Is An Insured is deleted and replaced by the following:
4. Any business entity acquired by you or incorporated or organized by you under the laws of any
individual state of the United States of America over which you maintain majority ownership
interest exceeding fifty percent. Such acquired or newly formed organization will qualify as a
Named Insured if there is no similar insurance available to that entity. However.
a. Coverage under this provision applies only until the expiration of the policy period in which
the entity was acquired or incorporated or organized by you.
b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before the
entity was acquired or incorporated or organized by you.
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense
committed before the entity was acquired or incorporated or organized by you.
d. Records and descriptions of operations must be maintained by the first Named Insured.
B. This Section 10. does not apply to newly formed or acquired organizations if coverage is excluded
either by provisions of the Coverage Part or by other endorsement(s) attached to it.
11. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
A. The requirements in Section IV -Conditions, Paragraph 2.a., that you must see to it that we are
notified of an "occurrence" applies only when the "occurrence" is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. A member or manager, 9 you are a limited liability company;
4. An executive officer or designee, if you are a corporation;
5. A trustee, if you are a trust; or
6. A designee, if you are any other type of organization.
B. The requirements in Section IV - Conditions Paragraph 2.b. that you must see to it that we receive
written notice of a claim or "suit" will not be considered breached unless the breach occurs after
such claim or "suit" is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership,
3. A member or manager if you are a limited liability company;
4. An executive officer or designee, if you are a corporation;
S. A trustee, if you are a trust; or
S. A designee, if you are any other type of organization.
Knowledge of an "occurrence," claim or "suit" by the agent, servant or "employee" of any insured
shall not in itself constitute knowledge of the insured unless an officer or designee shall have
received notice from its agent, servant or "employee ".
12. BODILY INJURY
Paragraph 3. of the definition of "bodily injury" in the Section V - Definitions is replaced by the
following:
3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental
anguish or death resulting from any of these at any time.
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13. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS
We have the right to recover our payments from anyone liable for an injury covered by this policy. We
will not enforce our right against any person or organization for whom you perform work under a written
contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the agreement.
14. MEDICAL PAYMENTS
If Coverage C Medical Payments is not otherwise excluded, the Medical Expense Limit provided by this
policy shall be the greater of
A. $10,000, or
B. The amount shown in the Declarations.
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Paragraph 2.a.(1)(d) of Section II - Who Is An Insured is replaced by the following.
(d) Arising out of his or her providing or failing to provide professional health care services However,
this exclusion does not apply to nurses, emergency medical technicians or paramedics who are
employed by you to provide medical or paramedical services to your employees.
16. BROADENED MOBILE EQUIPMENT
Paragraph 121(1) of Section V - Definitions is replaced by the following
(1) Equipment designed primarily for
(a) Snow removal:
(b) Road maintenance, but not construction or resurfacing, or
(c) Street cleaning provided that vehicles have a Gross Vehicle Weight of 1,000 pounds or greater,
17. INCIDENTAL MALPRACTICE LIABILITY
Paragraph 3. of Section V - Definitions is replaced by the following
3. "Bodily injury" means bodily injury, sickness. disease or "incidental medical malpractice' sustained
by a person, including mental anguish or death resulting from any of these at any time
The following is added to Section V - Definitions.
23. "Incidental medical malpractice" means injury arising out of the negligent rendering or failure to
render medical or paramedical services to persons by any physician, dentist, nurse, emergency
medical technician or paramedic who is employed by you to provide such services to your
employees, provided you are not engaged in the business or occupation of providing any
services referred to in this definition.
18. NON -OWNED AIRCRAFT
The following is added to Subparagraph g. of 2., Exclusions of Section I - Coverage A Bodily Injury
And Property Damage Liability:
(6) An aircraft with a paid crew. that is hired, chartered or loaned but is not owned by any insured.
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19. PROPERTY DAMAGE - ELEVATORS
The following is added to Subparagraph j. of 2., Exclusions of Section I - Coverage A Bodily Injury
And Property Damage Liability:
Paragraphs (3) and (4) of this exclusion do not apply to damages that result from the use of elevators.
All other terms and conditions of your policy remain unchanged.
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