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HomeMy WebLinkAboutLakeseide Industries, Inc., Paradise Bay Road, Phase II Project. T ,5 1^I CONTRACT FV ff - JEFFERSON COUNTY, WASHINGTON THIS AGREEMENT, made and entered into this �?A day of !'t 2015, between the COUNTY OF JEFFERSON, acting through the Jefferson County Commissioners and eand a Director of Public Works under and by virtue of Title 36, RCW, as amended and Lakeside Industries Inc. of Port Angeles, 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 Paradise Bay Road in Jefferson County from M.P. 0.37 to M.P. 1.53, in seeding, roadside restoration, and other work, all in accordance with the Contract Plans, Contract Provisions, and the Standard Specifications. for the total sum of Nine Hundred Seventv One Thousand Three Hundred Twenty Three Dollars and Sixty Cents ($971.323.60) 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 73 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 famish 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. 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 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. Any 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 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. 9. The Contractor will declare management option of the statutory retained percentage on Exhibit A. 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. q Executed by the Contractor IV— / '2015 Contractor: (Please print) By: P,400 Please print) (Signature) State of Washington, Contractor Registration Number COUNTY OF J FFERSON BOARD OF MI David Phil lohnsori, Member Kler, Member Approv I d as tt� orm only: � David Alvarez Date Deputy Prosecuting Attorney Monte einders, P.E. / Date Public Works Director /County Engineer 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) Name and Title of Author*d RAprespntative (Plead print) Signature of Authorize Representative ❑ I am unable to certify to the above statement. An explanation is attached. CONTRACFBOND Bond No. 106255243 JEFFERSON COUNTY, WASHINGTON KNOW ALL MEN BY THESE PRESENTS: That Lakeside Industries, Inc. , of Port Angeles, WA. , as Principal, and Travelers Casualty and Surety company of America as Surety, are jointly and severally held and bound unto the COUNTY OF JEFFERSON, the penal sum of Mime Hundred Seventy One Thousand Three Hundred Twenty Three Dollars and Sixty Cents ($ 971,323 N), 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 9th day of April A-D_, 2015, the said Lakeside Industries, Inc_ , Principalherein, executedacertaincontrac twiththeCountyofJefferson,bythe terms, conditions and provisions of which contract the said Lakeside Industries, 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 Paradise Bay Road, Phase 11 Priest M P 0.37 to M P 1.53, County Road Project CR1873 County Road 503608 i* 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 [natters and things by tho said Principal undertaken to be performed under said contract, upon the terms proposed therein, and within the time prescnbeo therein, and until the same is accepted, and shall pay all laborers, mechanics, subcontractors and materialmen, and all person$ 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 15thdayof April 2015. Travelers Casualty and Surety Lakeside Industries, Inc. PRINCIPAL By:�� C(--a /- riL.CrtS'A� Company of America SURE COMPANY B• By: Susan B. Larson Attorney -in -fact Address of local office and agent of surety company: Parker, Smith 6 Feek, Inc. 2233 112th Ave NE Bellevue, WA 98004 POWER OF ATTORNEY TRAVELERS/'J Farmington Casualty Company SL 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 St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 22fi Certificate No. 006219849 N2 J KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United 3tates Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Compan ( is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized un r the laws of the State of Wisconsin therein collectively called the "Companies "), and that the Companies do hereby make, constitute and appoint Dcanna M. French, Jill A. Hoyle, Susan H. Larson, Scott Fisher, Elizabeth R. Hahn, Jana M. Roy, Scott McGiIvray, Minder L. Rankin. Ellen Hamlin, Ronald J. Lange. John Claeys, Roger Kultenhach, and Guy P. Armficld of the City of Bellevue , State of Washington , their true and lawful Air( each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional o other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this I6lh day of January 2015 Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company SL Paul Guardian Insurance Company SL Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company RF bl QO\'0.FOMS `9 JPJ iN� g49i qF:.t 9HOS CIW MWOY #' 6r $� 19Ti nrawaraat �. �(ta�Ynnr,,''anronnrp:.ri CONN.' i� 1982 0 x,` U Nunram14,W4 Y 1951 �seaL ^} ssxL;a' m , „ o ; � fsw x�,f ey. ....... tg *. n+ State of Connecticut By: City of Hartford ss. Ruben L. Raney, enicr Vice President and of On this the 16th day of January 201-5 , before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., S Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Tr�eler., Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to du, executed the for can instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. �,TCT In Witness Whereof, I hereunto set my hand and official seal. ' TAii ' W wA C • VJ.�!� `^ My Commission expires the 30th day of June, 7016. * jOfIBlIO # Mane C. Teneault, Notary Public 58440 -8 -12 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER Jim EXHIBIT A 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) following final acceptance of the work. Date Signed B. I hereby elect to have the Owner deposit the retained percentage of this contract in an interest bearing 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 percentage accrues. 1 hereby designate as the repository for the escrow of said funds. I hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of placing said percentage in escrow and investing it as authorized by statute. The Owner shall not be liable in any way for any fees in connection therewith. Date �/ — Signed not or RETAINAGE BOND Bond No. 106255244 KNOW ALL MEN BY THESE PRESENTS, that LAKESIDE INDUSTRIES, INC. as Principal authorized to do business in the State of Washington and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA as Surety, a corporation organized and existing under the laws of the State of CONNECTICUT and authorized to transact business in the State of Washington as Surety, are jointly and severally held and bound unto JEFFERSON COUNTY as Obligee in the penal sum of FORTY EIGHT THOUSAND FIVE HUNDRED SIXTY SIX AND 18 /100THS Dollars ($ 48,666.18 ), which is 5% of the Principal's bid. WHEREAS, on the 9TH day of APRIL 1 2015 the said Principal, herein, executed a contract with the Obligee, for Paradise Bay Road, Phase II Project M.P. 0.37 to M.P. 1.53, County Road Project CR1873, County Road 503608 WHEREAS, said contract and RCW 60.28 require the Obligee to withhold from the Principal the sum of 5% from monies earned on estimates during the progress of the construction, hereinafter referred to as earned retained funds. AND NOW WHEREAS, Principal has requested th at the Obligee not retain any earned retained funds as allowed under RCW 60.28. NOW, THEREFORE, the condition of this obligation is such that the Principal and Surety are held and bound unto the beneficiaries of the trust fund created by RCW 60.28 in the penal sum of 5% of the final contract cost which shall include any increases due to change orders, increases in quantities of work or the addition of any new item of work. If the Principal shall use the earned retained funds, which will not be retained, for the trust fund purposes of RCW 60.28, then this obligation shall be null and void, otherwise, it sh,, remain in full force and effect. This bond and any proceeds therefrom shall be made subject to all claims and liens and in the same manner and priority as set forth for retained percentages in RCW 60.28. PROVIDED HOWEVER, that: 1. The liability of the Surety under this bond shall not exceed 5% of the total amount earned by the Principal if no monies are retained by the Obligee on estimates during the progress of construction. 2. Any suit under this bond must be instituted within the time period provided by applicable law. WITNESS our hands this 15th day of April 120 15 Travelers Casualty and Surety Company of America LAKESIDE INDUSTRIES, INC. Surety By Susan B. Larson, Attorney -in -Fact "(Ju;TGIJ Parker. Smith & Feek, Inc. 2233112 1h Ave NE, Bellevue, WA 98004 Name and Address of Local Agent Cr() / T &i5;wzc4t- Principal POWER OF ATTORNEY TRAVELERS J� Farmington Casualty 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 St, Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 228923 Certificate No. 006219050 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Ins ante Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United itates Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Compan � is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized un r the laws of the State of Wisconsin (herein collectively called the "Companies' ), and that the Companies do hereby make, constitute and appoint Deanna M. French, Jill A. Boyle. Susan B. Larson, Scutt Fisher, Elizabeth R. IJahn. Jana M. Roy, Scutt McGiIviay, Mindee L. Rankin, Ellen cll, Jim Hamlin, Ronald J. Lange, John Claeys, Roger Kaltenhach, and Guy F. Armlield Of the City of Bellevue , State of Washinglon , their true and lawful Attorney(s)- i`__`''jIjFact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guar an acing the performa cc of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to he hereto affixed, this 16th day of January 2015 Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company cnsvar N[y ? rA g `4 i 1 Y 8 S O woa >on.,>ii' °M1y -OF9 n fr 41IED � Err ]� -r �xt` -i° 8 anarrono, °x: jxwnarn i • r J9SJ - o`;SEaI.Jo n Coro. ¢ �p g ° • i CONN. % `a^ NEE vf`F.rvce c' + +a "mss ;58EL,ae a, e> Sate of Connecticut By: City of Hartford ss. Robert L. Raney, . moor Vice President On this the l6th day of January 2015 before me personally appeared Robert L. Raney, who acknowledged him elf to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Si . Paul Fire and Marine Insurance Company, SL Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. p,7ET In Witness Whereof, I hereunto set my hand and official sea]. ' � \ t \ W wk v • �� My Commission expires the 30th day of June, 2016. A0(IBU� * Maria C. Tetreaull, Notary Public 58440 -8-12 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER A�RO® CERTIFICATE OF LIABILITY INSURANCE DA 0TE (IM 4/ 6/2011 n 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 ril lhts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PAX 425- 709 PHONE Exit- 425 -709 -3600 No: AC 7460 Parker, Smith S Feek, Inc. 2233 112th Avenue NE _ E -MALL Bellevue, WA 98004 INSURER (S) AFFORDING COVERAGE NAIC If _ INSURERA: Zurich American Insurance Co. INSURER B: INSURED Lakeside Industries, Inc. P.O. BOX 7016 INSURER C : INSURER D: Issaquah, WA 98027 INSURER E : _ INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI 3Y PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T dE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L R TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMMDY /YYYY MMIDDWYYY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY GLA311921531111 X X 6/1/2014 6/112015 EACH OCCURRENCE $ 1,00 ,000 DAMAGE TO RENTED I PREMISES Ea occurrence $ 300, 00 MED EXP (Any one person) $ 10,0 0 CLAIMS -MADE 7XI OCCUR PERSONAL& ADV INJURY $ 1,00 ,000 GENERAL AGGREGATE $ 2,00 ,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,00 ,000 $ POLICY X PRO - X', LOC 'JECT • AUTOMOBILE LIABILITY GLA399263010 6/1/2014 6/1/2075 COMBINED SINGLE LIMIT E accident) 2,DD ,ODD BODILY INJURY (Per person) $ X ANY AUTO ,, ! BODILY INJURY (Per accident) _ $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED n HIREDAUTOS AUTOS I PROPERTY DAMAGE Per areid °nt $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE' OED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y I N ANYPROPRIETOR /PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA GLA399263010 _ WA State Stop Gap Only 6/1 /2014 6/1/2015 WC STATU- X OR - ),000 E EACH ACCIDENT $ 1,00 E.L. DISEASE - EA EMPLOYEE $ 1,00 ,000 E. L. DISEASE - POLICY LIMIT $ 7.00 ,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks schedule, If more space is required) LI Job No. 045062 - Paradise Bay Road, Phase 2 Project. Jefferson County Department of Public Works is included as Additional Insured and coverage is primary and non - contributory per Endorsement U- L-1 175-F CW 04-13 attached. Waiver of Subrogation applies per Endorsement U -GL -925 -B CW 12 -01 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL =D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Jefferson County Department of Public Works AUTHORIZED REPRESENTATIVE 623 Sheridan St Port Townsend, WA 98368 ©1988.2010 ACORD CORPORATION. All rigt*s reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Additional Insured — Automatic — Owners, Lessees Or Contractors 0 ZURICH Policy No. I Eff. Date of Pol. I Exp. Date of Pol. I Eff. Date of End. I Producer No. I Add]. Prem I Return Fjrem. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization wt are required to add as an additional insured on this policy under a written contract or written agreement. Such or organization is an additional insured only with respect to liability for "bodily injury', "property damage' or "I and advertising injury' caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products- completed op hazard ", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to pr( such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: 'Bodily injury', "property damage" or "personal and advertising injury' arising out of the rendering of, or render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. you for to This exclusion applies even if the claims against any insured allege negligence or other wrongdoing I in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which cau ed the "bodily injury" or "property damage', or the offense which caused the "personal and advertising injury", invol ed the rendering of or the failure to render any professional architectural, engineering or surveying services. U -GL- 1175 -F C: (04/13) P ge 1 of 2 C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Secticjn IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit' as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy iss ad by another insurer under which the additional insured may be an insured in any capacity. This provision dc as not apply to insurance on which the additional insured is a Named Insured if the written contract or written agrE ement requires that this coverage be primary and non - contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and n seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Com ercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an ad itional insured, in which the additional insured on our policy is also covered as an additional insured on anothei policy providing coverage for the same occurrence ", offense, claim or "suit'. This provision does not apply to anj policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary an J non- contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. U- GL- 1175 -F CV 3) Pa e2of2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Waiver Of Subrogation (Blanket) Endorsement PolicN No, Fff. Dat< of Pot. E.aP. Date of Poi, [ff. Date of End- Producer Add 'I. Prcm Return rem. 5 S I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFLLL1. This endorsement modifies insurance provided under ;he: Commercial General Liability Coverage Pats The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or aercemcnt, which is executed before a loss, to waive your rights of recove ' from others, we agree to waive our rights of recovery. I his waiver of rights shall not he construed zo be a waiver with re ect to any other operations in which the insured has no contractual interest. 1p Department 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: Monte Reinders, Public Works Director /County Engineer Agenda Date: April 27, 2015 Subject: Execution of Contract with Lakeside Industries, Inc. Paradise Bay Road, Phase II Project, M.P. 0.37 to M.P. 1.53 Co. Rd. No. 503608, CR1873, R.A.P. Project No. 1609 -02 Statement of Issue: The issue is requesting execution of the Contract document for the Paradise Bay Road, Phase II Project, CR1873 with Lakeside Industries, Inc. for the bid amount of $971,323.60. Analysis /Stategic Goals /Pros It Cons: This project is included in the officially adopted 2015 -2020 Transportation Improvement Program as Item No. 10. This project is also included in the adopted 2015 Annual Construction Program as item No. 8. The purpose of this project is to improve Paradise I Road from M.P. 0.37 to M.P. 1.53. Bids for this project were obtained using the standard bidding process. The lowest responsive bidder was Lakeside Industries, Inc. of Port Angeles, WA. The Contract now needs to be executed for this project to proceed. Fiscal Impact /Cost Benefit Analysis: This project is funded at 90% by the Rural Arterial Program, through the State of Washington County Road Administration Board. The contract amount for this project is $971,323.60. This project is included in the adopted 2015 roads budget. Recommendation: Public Works recommends that the Board execute all three (3) originals of the contract with Lakeside Industries, Inc. and return two (2) originals to Public Works for further processing. Department Contact: John Wayand, Project Manager, 385 -9377 Review Byz/ 7 PhilirMarley,- C911 m ' y Adm strator CONTRACT REVIEW FORM LAKESIDE I1q0U5 -rR IE5, INC. CONTRACT WITH: — (Gem& eta to be determined by bidding p CONTRACT FOR: Paradise Bay Road, Phase II CR1873 Co. Rd. No. 503608, M.P. 0.37 to M.P. 1.53 COUNTY DEPARTMENT: Public Works For More Information Contact: Contact Phone #: RETURN TO: Tina RETURN BY: MAR 3 0 2015 JEFFERSON COUNTY 173EWWtZ� FEB 242015 AFFEASON CO a s @y i. 3 -17 -2015 (;OIVIMISSIOIV' S -$ 971)323. 60 AMOUNT: 09,469.9CrE�imate�- PROCESS: Fund: 180- 000 -010 Revenue: 33403.72 Expenditure: Matching Funds Required: Sources(s) of Matching Funds 595.00.65 Yes 31110.00 Exempt from Bid Proce Consultant Selection Pr Cooperative Purchase X Competitive Sealed Bid Small Works Roster Vendor List Bid RFP or RFQ Other Step 1: REVIEW BY RIS Review by: Date Reviewed: RAPPROVED FORM* Returned for revision (See Comments) Comments 'i i S v- iv I A ivy_. '1)A ,:1,c; re -e CT cLz«, I C ( s) fn ��(jz (i/6 L•s Tien l -T� Fe - Cr , Y, Step 2: REVIEW BY PROSECUT N TT Review by: — LLv Z Date Reviewed: - — yV APPROVED AS TO FORM Re d for rtMjon (See Comments) Comments .Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER ORIGINALS Step 5: SUBMIT TO BOCC FOR APPROVAL Submit originals and 8 copies of Contract, Review Form, and Agenda Bill to BOCC Office. Place "Sign Here" markers on all places the BOCC needs to sign. MUST be in BOCC Office by 5 p.m. TUESDAY for the following Monday's agenda. (This form to stay with contract throughout the contract review process.) .Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER ORIGINALS Step 5: SUBMIT TO BOCC FOR APPROVAL Submit originals and 8 copies of Contract, Review Form, and Agenda Bill to BOCC Office. Place "Sign Here" markers on all places the BOCC needs to sign. MUST be in BOCC Office by 5 p.m. TUESDAY for the following Monday's agenda. (This form to stay with contract throughout the contract review process.)