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HomeMy WebLinkAboutSealevel Bulkhead Builders, Inc. - 0501171 ` N 6 ` 1 ` i 1 CONTRACT ,� A a93 -- JEFFERSON COUNTY, WASHINGTON THIS AGREEMENT, made and entered into this Ni day of '�W�GL , 20�, between the COUNTY OF JEFFERSON, acting through the Jefferson County Commissioners and 14e Director of Public Works under and by virtue of Title 36, RCW, as amended and Sealevel Bulkhead Builders, Inc. of Kingston, Washington hereinafter called the Contractor. WITNESSETH: That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the parties hereto covenant and agree as follows: 1. The Contractor agrees to furnish all labor and equipment and do certain work, to -wit: That the Contractor herein will undertake and complete the following described work: This work involves removing three culverts from an abandoned portion of Undie Road in west Jefferson County, near Forks, Washington. The work consists of excavating and removing one 48" diameter steel casing pipe and two 24" diameter corrugated metal pipes from an active landslide area at Undie Road MP 1.1, and transporting the pipes to the Jefferson County Tower Creek pit at Upper Hoh Road MP 7.5, or disposing if they are not in a reusable condition for the total sum of Ten thousand four hundred eighty six dollars and seven cents dollars ($10,486.07) 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 3 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. Revised 1/2017 Page 1 of 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 Revised 1/2017 Page 2 of 6 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 Revised 1/2017 Page 3 of 6 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. Revised 1/2017 Page 4 of 6 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 Contractor: ) . • , , S eay , f -i ���(.t �,[ Gt-2 C;c� . (A t!dG►rs (Please print) By: U (Aq Vl l-� G� �✓� (Please print) (Si to State of Washington, Contractor Registration Number COUNTY OF JEFFERSON BOARD OF COMMISSIONEERS Luc 111 Kathleen Kler, Chair Katd Dean, ber David ulli an, Member Approved as to form only: 1ped � g to form: S�//llliff (�'"_',/s.-- Date: Philip C. Hunsucker, Chief Civil Deputy Prosecutor Jefferson Countv Prosecutor's Office onte Rei rs, P.E.---- s — Date Pulylle--Works`birector/County Engineer Revised 1/2017 Page 5 of 6 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) JeKn t f - (2o* �-cn - p4741 (el;- Namp.and Title of Authorized Representative (Please print) of Authd ze Representative F] I am unable to certify to the above statement. An explanation is attached. Revised 1/2017 Page 6 of 6 Department of Public Works O Consent Agenda Page 1 of 1 Jefferson County Board of Commissioners Agenda Request To: Board of Commissioners Philip Morley, County Administrator From: Monte Reinders, P.E., Public Works Director/County Engineer J Agenda Date: May 1, 2017 Subject: Execution of Contract with Sealevel Bulkhead Builders, Inc. Undie Road MP 1.1 Culvert Removal, County Project No. 18019900 County Road No. 150009 Statement of Issue: Execution of Contract with Sealevel Bulkhead Builders, Inc. for the above referenced project. Analysis/Strategic Goals/Pro's £t Con's: During the winter of 2015-2016 Public Works installed three culverts in the vicinity of Undie Road MP 1.1 as part of the emergency repairs to keep the road open. Since that time, a new road was constructed and the existing road was abandoned and is succumbing to ongoing slide activity. This contract is for removal of the three culverts and transport to Jefferson County's Tower Creek pit on Upper Hoh Road. The culverts consist of one 48 inch diameter X 44 ft. long solid steel casing, valued at $12,000, and two 24 inch diameter X 30 ft. long corrugated metal pipes, valued at approximately $1,500 if salvaged intact. Fiscal Impact/Cost Benefit Analysis: The bid amount is $10,486.07. This will be funded at 100% by the County Road Fund. Recommendation: Public Works recommends that the Board execute all three originals of the Contract with Sealevel Bulkhead Builders, Inc. and return two originals to Public Works. Department Contact: Mark Thurston, P.E., Project Manager, 385-9160. Reviewed By: ilip o ey, County Ad istrator Date ACOR©® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/17/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Durham and Bates Agencies, Inc. 720 SW Washington St. Ste250 Portland OR 972053554 CONTACT NAME: Lisa Harris ._ PHONE FAX M No, Ext): 503-224-5170 _ ALc. No): 503-221-0540 -- E-MAIL INSURERS AFFORDING COVERAGE NAIC # 2/1/2017 INSURER A:Subscription EACH OCCURRENCE $1,000,000 INSURED INSURER B :Am Lon shore Mutual Assn Sealevel Bulkhead Builders, Inc. PO Box 375 Kingston WA 98346 INSURER C :Ohio Casualty Insurance Company 24074 - INSURER D : INSURER E DAMAGE TO REN PREMISES Ea occuTEDrrence $50,000 INSURER F X Marine GL _ COVERAGES CERTIFICATE NUMBER: 485282432 RFVISIAN Nt1MRFR- 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. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP LIMITS MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY PDB -52368 2/1/2017 2/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO REN PREMISES Ea occuTEDrrence $50,000 MED EXP (Any one person) $10,000 X Marine GL _ X I WA Stop Gap PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ` POLICY JE 0 I� LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: C AUTOMOBILE LIABILITYBAS(18)57708566 2/1/2017 2/ COMBINED SINGLE LIMIT1/2018 Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE $ Per accident A X UMBRELLA LIAB OCCUR DB -52360 2/1/2017 2/1/2018 EACH OCCURRENCE $4,000,000 X AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A ALMA01683-01 1/23/2017 1/23/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B USL&H Coverage ALMA01683-01 1/23/2017 1/23/2020 Limit -Statutory DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage A Subscription Carriers: MGL - United States Fire Ins Co. (NAIC #21113): Liberty International Underwriters (NAIC #23043). Coverage A Subscription Carriers: Excess Liability - United States Fire Ins Co. (NAIC #21113): Endurance American Insurance Co. (NAIC #10641). RE: Project removal of three culverts from abandoned portion of Undie Road in west Jefferson County. Jefferson County Public Works is included as an additional assured as respects the Marine General Liability and Automobile Liability per the attached endorsements. CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jefferson County Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 623 Sheridan St. ACCORDANCE WITH THE POLICY PROVISIONS. Port Townsend WA 98368 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD .1. COMMERCIAL AUTO CA 88 10 01 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGEINDEX SUBJECT PROVISION NUMBER �,,�► ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 18 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 21 EMPLOYEES AS INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 22 EXTRA EXPENSE -BROADENED COVERAGE 10 GLASS REPAIR - WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN t LEASE GAP 14 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 19 SECTION II - LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture: or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization; ©2010 Liberty Mutual Insurance Company. All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED is amended to include the following as an insured: `may h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION 11 - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION 11 - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or Q2010 Liberty Mutual Insurance Company. All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 2 of 7 ENDORSEMENT NO.: 2 ATTACHED TO AND FORMING PART OF POLICY NO.: PDB -52368 ISSUED TO: SEALEVEL BULKHEAD BUILDERS, INC. ADDITIONAL ASSURED AND WAIVER OF SUBROGATION ENDORSEMENT It is agreed that the Company waives its right of subrogation against any person or organizations to whom the Named Assured is obligated by written contract to provide such waiver, but only to the extent of such obligation and only with respect to operations by or on behalf of the Named Assured or to the facilities of or used by the Named Assured. It is further agreed that to the extent that the Named Assured is obligated by written contract to name any person or organization as additional assureds hereunder, the Company agrees that such persons or organizations shall be considered as Additional Assureds but only with respect to operations performed by or on behalf of the Named Assured or to the facilities of or used by the Named Assured. All other terms, conditions, limitations and exclusions remain unchanged. CONTRACT REVIEW FORM CONTRACT WITH: To be determined ,r (Contractor/Consultant) CONTRACT FOR: Undie Road MP 1.1 Culvert Removal TERM: n/a COUNTY DEPARTMENT: Public Works For More Information Contact: Mark Thurston APP Contact Phone ?t: (360) 385-9210 V 5 R-ETURN T: Mark Thurston RETURN BY: 4/J#&F E R S O N (Person in Department) — liz i U1 AMOUNT: $14,097 (Engineers Estimate) PROCESS: Exempt from Bid Process Consultant Selection Process Revenue: Road fund Cooperative Purchase Expenditure: 180000010.545.00.48 Competitive Sealed Bid Matching Funds Required: no X Small Works Roster Sources(s) of Matching Funds Vendor List Bid RFP or RFQ Other Step 1: REVIEW 7BY7TM�ENT Review by: Date Reviewed: `APPROVED FORM Returned for revision (See Comments) Comments Step 2: REVIEW BY PPS Review by: C Date Reviewed: Ez/ APPROVED AS TO FORM Comments w � �nT! Philip C. Hunsucker, Chief Civil Deputy Prosecutor Jefferson Countv Prosecutor's office for revision (See Comments) Step 3: (If required) DEPARTMENT MAKES REVISIONS AND RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORYEI` Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF ORIGINALS j /7 Step 5: SUBMIT TO BOCC FOR APPROVAL m U t1LI if Submit originals and 6 copies of Contract and Review Forwith Agenda Bill to BOCC Office. U U Place "Sign Here" markers on all places the BOCC needs to sign. MUST be in BOCC Office by 4:30 p.m. TUESDAY for the following Monday's agenda.} U {This form is to stay with the contract throughout the contract review process and accompany the Agenda Bill, JE F F E RS )N COUNTY PROSECUTING ATTGRtiEY rev. 12, 10%2014