HomeMy WebLinkAboutPublic Utiltiy District (PUD) No. 1, Jefferson County re: ARPA Broadband Grant Match (ins ex 12.31.22) - 020722GRANTEE AGREEMENT WITH JEFFERSON COUNTY PUBLIC UTILITY
DISTRICT NO. 1 (PUD) FOR LOCAL MATCH FOR A BROADBAND GRANT
This Grantee Agreement ("Agreement") is by and between Jefferson County, a Washington political
subdivision ("County") and Jefferson County Public Utility District No. 1, ("Grantee").
WHEREAS, on March 11, 2021, President Biden signed the American Rescue Plan
(ARPA) into law; and
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WHEREAS, the ARPA allows that funds received under the act can be used to promote
the development of broadband infrastructure; and
WHEREAS, the PUD, being a major provider of broadband internet connectivity in
Jefferson County, has a need for funds to increase broadband coverage within and throughout
Jefferson County; and
WHEREAS, the Jefferson County Board of Commissioners previously awarded the PUD
an ARPA grant of $150,000 for this purpose; and
WHEREAS, the Board of Commissioners wished to make the PUD's broadband grant
submission more competitive by committing $750,000 in ARPA funding to increase the local
grant match percentage to 20%; and
WHEREAS, the PUD was awarded the grant for which they applied,
NOW, THEREFORE, in consideration of the foregoing recitals, which are incorporated
herein by reference, and the terms and conditions set forth below, the parties agree as follows:
1. Effective Date and Term. This Agreement shall commence on when last executed
by the parties and remain in effect until December 31, 2022, unless terminated earlier by the
County in writing.
2. Grant Amount and Grantee's Use of Grant Funds. The Grantee shall ensure that the
any funds expended are eligible in accordance with the terms of the grant, to include the grant
proposal attached. The Grant amount is $750,000.
3. Termination, The County may terminate this Agreement, for convenience or
otherwise and for no consideration or damages, upon prior notice to the Grantee.
4. Independent Grantee. Each party under this Agreement shall be for all purposes an
independent Grantee. Nothing contained herein will be deemed to create an association, a
partnership, a joint venture, or a relationship of principal and agent, or employer and employee
between the parties. The Grantee shall not be, or be deemed to be, or act or purport to act, as an
employee, agent, or representative of the County for any purpose.
5. Indemnification. The Grantee agrees to defend, indemnify and hold the County, its
officers, officials, employees, agents and volunteers harmless from and against any and all claims,
injuries, damages, losses or expenses including without limitation personal injury, bodily injury,
sickness, disease, or death, or damage to or destruction of property, which are alleged or proven
to be caused in whole or in part by an act or omission of the Grantee, its officers, directors,
employees, and/or agents relating to the Grantees' performance or failure to perform under this
Agreement. The section shall survive the expiration or termination of this Agreement.
6. Insurance. Prior to commencing work, the Grantee shall obtain at its own cost and
expense the following insurance coverage specified below and shall keep such coverage in force
during the terms of the Agreement.
Commercial Automobile Liability Insurance providing bodily injury and property damage
liability coverage for all owned and non -owned vehicles assigned to or used in the performance
of the work for a combined single limit of not less than $500,000 each occurrence with the County
named as an additional insured in connection with the Grantee's performance of his Agreement.
This insurance shall indicate on the certificate of insurance the following coverage: (a) Owned
automobiles; (b) Hired automobiles; and, (3) Non -owned automobiles.
Commercial General Liability. Insurance in an amount not less than a single limit of
$1,000,000 per occurrence and an aggregate of not less than two (2) times the occurrence amount
($2,000,000.00 minimum) for bodily injury, including death and property damage, unless a
greater amount is specified in the contract specifications.
The commercial general liability insurance coverage shall contain no limitations on the scope of
the protection provided and include the following minimum coverage:
Broad Form Property Damage, with no employee exclusion;
b. Personal Injury Liability, including extended bodily injury;
C. Broad Form Contractual/Commercial Liability — including coverage for products
and completed operations;
d. Premises — Operations Liability (M&C);
Blanket Contractual Liability.
The County shall be named as an "additional named insured" under all insurance policies required
by this Agreement, except Professional Liability Insurance when not allowed by the insurer, and
shall include a provision prohibiting cancellation of said policy except upon thirty (30) days prior
written notice to the County.
Such insurance coverage shall be evidenced by one of the following methods: (a) Certificate of
Insurance; or, (b) Self-insurance through an irrevocable Letter of Credit from a qualified financial
institution.
The Grantee shall furnish the County with properly executed certificates of insurance that, at a
minimum, shall include: (a) The limits of overage; (b) The project name to which it applies; (c)
The certificate holder as Jefferson County, Washington and its elected officials, officers, and
employees with the address of Jefferson County Risk Management, P.O. Box 1220, Port
Townsend, WA 98368, and, (d) A statement that the insurance policy shall not be canceled or
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allowed to expire except on thirty (30) days prior written notice to the County. If the proof of
insurance or certificate indicating the County is an "additional insured" to a policy obtained by
the Grantee 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 Grantee to obtain the full text of that
endorsement and forward that full text to the County. Certificates of coverage as required by this
section shall be delivered to the County within fifteen (15) days of execution of this Agreement.
Failure of the Grantee to take out or maintain any required insurance shall not relieve the Grantee
from any liability under this Agreement, nor shall the insurance requirements be construed to
conflict with or otherwise limit the obligations concerning indemnification of the County.
The Grantee's 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, with the exception of Professional Liability Insurance, so affected shall
protect all the parties and shall be primary coverage for all losses covered by the above described
insurance.
Insurance companies issuing the Grantee's insurance 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 insurance policy.
All deductibles in the Grantee's insurance policies shall be assumed by and be at the sole risk of
the Grantee.
Any deductibles or self -insured retention shall be declared to and approved by the County prior
to the approval of this Agreement by the County. At the option of the County, the insurer shall
reduce or eliminate deductibles or self -insured retention, or the Grantee shall procure a bond
guaranteeing payment of losses and related investigations, claim administration and defense
expenses.
Any judgments for which the County may be liable, in excess of insured amounts required by this
Agreement, or any portion thereof, may be withheld from payment due, or to become due, to the
Grantee until the Grantee shall furnish additional security covering such judgment as may be
determined by the County.
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 insurance policy the
Grantee shall provide to comply with this Agreement.
The County may, upon the Grantee's failure to comply with all provisions of this Agreement
relating to insurance, withhold payment or compensation that would otherwise be due to the
Grantee.
The Grantee shall provide a copy of all insurance policies specified in this Agreement.
Written notice of cancellation or change in the Grantee's insurance required by this Agreement
shall reference the project name and agreement number and shall be mailed to the County at the
following address: Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA
98368.
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The Grantee's liability insurance provisions shall be primary and noncontributory with respect to
any insurance or self-insurance programs covering the County, its elected and appointed officers,
officials, employees, and agents.
Any failure to comply with reporting provisions of the insurance policies shall not affect coverage
provided to the County, its officers, officials, employees, or agents.
The Grantee's insurance shall apply separately to each insured against whom claim is made or
suit is brought, except with respect to the limits of the insurer's liability.
The Grantee shall include all Sub -Grantees as insured under its insurance policies or shall furnish
separate certificates and endorsements for each Sub -Grantee. All insurance coverage for Sub -
Grantees shall be subject to all the requirements stated in this Agreement.
The insurance limits mandated for any insurance coverage required by this Agreement are not
intended to be an indication of exposure nor are they limitations on indemnification.
The Grantee shall maintain all required insurance policies in force from the time services
commence until services are completed. Certificates, insurance policies, and endorsements
expiring before completion of services shall be promptly replaced. All the insurance policies
required by this Agreement 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.
The Grantee shall place insurance with insurers licensed to do business in the State of Washington
and having A.M. Best Company ratings of no less than A-, with the exception that excess and
umbrella coverage used to meet the requirements for limits of liability or gaps in coverage need
not be placed with insurers or re -insurers licensed in the State of Washington.
The County reserves the right to request additional insurance on an individual basis for extra
hazardous contracts and specific service agreements.
7. Worker's Compensation (Industrial Insurance).
The Grantee shall maintain workers' compensation insurance at its own expense, as
required by Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage
to Jefferson County Risk Management, upon request.
Worker's compensation insurance covering all employees with limits meeting all
applicable state and federal laws. This coverage shall include Employer's Liability with limits
meeting all applicable state and federal laws.
This coverage shall extend to any Sub -Grantee that does not have their own worker's
compensation and employer's liability insurance.
The Grantee expressly waives by mutual negotiation all immunity and limitations on
Liability, with respect to the County, under any industrial insurance act, disability benefit act, or
other employee benefit act of any jurisdiction which would otherwise be applicable in the case
of such claim.
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If the County incurs any costs to enforce the provisions of this subsection, all cost and fees
shall be recoverable from the Grantee.
8. Compliance with Laws. Guidelines, The Grantee shall comply with all federal,
state, and local laws and all requirements (including certifications and audits), to the extent
applicable, when seeking Reimbursement.
9. Maintenance and Audit of Records. The Grantee shall maintain records, books,
documents, and other materials relevant to its performance under this Agreement. These records
shall be subject to inspection, review and audit by the County or its designee, the Washington.
State Auditor's Office. If it is determined during the course of the audit that the Grantee was
reimbursed for unallowable costs under this Agreement or any, the Grantee agrees to promptly
reimburse the County for such payments uponrequest.
10. Notices, Any notice desired or required to be given hereunder shall be in writing,
and shall be deemed received five (5) days after deposit with the U.S. Postal Service, postage fully
prepaid, certified mail, return receipt requested, and addressed to the party to which it is intended
at its last known address, or to such other person or address as either party shall designate to the
other from time to time in writing forwarded in like manner:
Grantee
Kevin Streett
General Manager
Jefferson County Public Utility District No. 1
310 Four Corners Road
Port Townsend, WA 98368
Jefferson County
Mark McCauley
Interim County Administrator
Jefferson County Courthouse
1820 Jefferson Street
Port Townsend, WA 98368
11. Im}�roper Influence. Each party warrants that it did not and will not employ, retain, or
contract with any person or entity on a contingent compensation basis for the purpose of seeking,
obtaining, maintaining, or extending this Agreement. Each party agrees, warrants, and represents
that no gratuity whatsoever has been or will offered or conferred with a view towards obtaining,
maintaining, or extending this Agreement.
12. Conflict of Interest The elected and appointed officials and employees of the parties
shall not have any personal interest, direct or indirect, which gives rise to a conflict of interest.
1.3.Ti= Time is of the essence in this Agreement.
14. Survival. The provisions of this Agreement that by their sense and purpose should
survive expiration or termination of this Agreement shall so survive. Those provisions include
without limitation Indemnification and Maintenance and Audit of Records.
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15. Amendment. No amendment or modification to this Agreement will be effective
without the prior written consent of the authorized representatives of the parties.
16. Governing Law: Venue, This Agreement will be governed in all respects by the laws
of Washington state, both as to interpretation and performance, without regard to conflicts of law
or choice of law provisions. Any action arising out of or in connection with this Agreement may
be instituted and maintained only in a court of competent jurisdiction in Jefferson County,
Washington or as provided by RCW 36.01.050.
17. Non -Waiver. No failure on the part of the County to exercise, and no delay in
exercising, any right hereunder shall operate as a wavier thereof; nor shall any single or partial
exercise by the County of any right hereunder preclude any other or further exercise thereof or the
exercise of any other right. The remedies herein provided are cumulative and not exclusive of any
remedy available to the County at law or in equity.
18. Bindina Effect, This Agreement shall be binding upon and inure to the benefit of the parties
hereto and their respective successors.
19. ssi ng ment. Neither party shall assign or transfer any of its interests in or obligations
under this Agreement without the prior written consent of the other party.
20. Entire Agreement. This Agreement constitutes the entire agreement between the
County and the Grantee for the use of funds received under this Agreement and it supersedes all
prior or contemporaneous communications and proposals, whether electronic, oral, or written
between the parties with respect to this Agreement.
21. No Third -Party Beneficiaries. Nothing herein shall or be deemed to create or confer
any right, action, or benefit in, to, or on the part of any person or entity that is not a party to this
Agreement. This provision shall not limit any obligation which either party has to the Washington
State Department of Commerce of these grant funds, including the obligation to provide access to
records and cooperate with audits as provided in this Agreement.
22. Severability. In the event that one or more provisions of this Agreement shall be determined
to be invalid by any court of competent jurisdiction or agency having jurisdiction thereof, the remainder
of this Agreement shall remain in fiill force and effect and the invalid provisions shall be deemed
deleted.
23. Counternarts, This Agreement may be executed in counterparts, any of which shall be
deemed an original but all of which together shall constitute one and the same instrument.
24. Authorization. Each party warrants to the other party, that the person executing this
Agreement on its behalf has the full power and authority to do so.
25. Public Records Act. Notwithstanding any provisions of this Agreement to the contrary,
to the extent any record, including any electronic, audio, paper or other media, is required to be
kept or indexed as a public record in accordance with the Washington Public Records Act, Chapter
42.56 RCW (as may be amended), the Grantee agrees to maintain all records constituting public
records and to produce or assist the County in producing such records, within the time frames and
parameters set forth in state law. The Grantee also agrees that upon receipt of any written public
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record request, Grantee shall, within two business days, notify the County by providing a copy of
the request per the notice provisions of this Agreement.
(SIGNATURES APPEAR ON THE NEXT PAGE)
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IN WITNESS WHEREOF, this Agreement is executed and shall become effective as of the last date
signed below,
JEFFERSON COUNTY BOARD OF
COMM SSIONERS
By: ,� 2
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ZZ
Heidi Eisenhour, Chair DATE
'4e �
Alember
GrefBroth;rton, Member
SEAL:
ATTEST.
/-/ yl?-
DATE
!?& 2-
DATE
� (aj 6,rt 2-/7
Carolyn &1loway GATE
Clerk of the Board
Approved as to fonn only:
I I I
February 4, 2022
hi-Iip C."Hunsucker--'-- DATE
Chief Civil Deputy Prosecuting Attorney
JEFFERSON PUBLIC UTILITY
DISTRICT NO. I
Kevin Streett, General Manager DATE
8
Board of Commissioners:
Jeff Randall, District t
Kenneth Collins, District 2
Dan Toepper, District 3
Kevin Streett, General Manager
January 27, 2022
To: Mark McCauley &
Jefferson County Board of Commissioners
1820 Jefferson Street
Port Townsend, WA 98368
RE: American Rescue Plan Funding Request
P D
Jefferson County
Public Utility District
The PUD greatly appreciates Jefferson County's pledge of $750,000 in matching funds for
our successful application to the Washington State Broadband Office to connect around
650 homes with fiber optic cable.
As you know, the Covid-19 pandemic has shown that access to broadband is essential for
full engagement with work, schooling, healthcare, and even the basics citizenship.
Jefferson County PUD has made it a goal to facilitate access to broadband for all residents
in its electric service territory.
This grant project is one of many the PUD has applied for and one of two the PUD has been
awarded to date. The total cost of the project is $11.4M. The award from the state is
$9.7M. 100 miles of fiber will be run overhead and underground to connect the hundreds
of homes in the project area, which is broken up into the following three zones: Cape
George Rd. along Discovery Bay to Middlepoint Rd; Woodland Hills between Hwy 19 and
Kala Point; and Marrowstone Island.
In each zone, residents have struggled for years to gain access to adequate and functional
internet service. Most have outdated DSL delivering barely better than dial -up speeds, far
below the minimum broadband speed standard of 25mbps downloads and 3mbps uploads.
Some are unable to get any internet at all, or use expensive and unreliable service like
cellular hotspots and satellite connections.
Construction on the project is expected to begin in the second half of 2022 and will be
completed in 2023. Unique in WA state, the PUD will both construct and maintain the fiber
and provide retail internet service to end users over its open access network, guaranteeing
high quality, affordable, reliable service from day one.
9
Jefferson County's matching contribution to this project was essential, and helped make
our application the only funded grant directly to a PUD from the State Broadband Office.
The commissioners and I greatly appreciate the generosity and camaraderie the County
has shown in its willingness to share federal funding with the PUD and other local agencies
during the last year. Please let me know if you have any questions or would like additional
information.
Sincerely,
LL9:;?--��
Kevin Streett
General Manager
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JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
CONSENT AGENDA REQUEST
TO: Board of County Commissioners
FROM: Mark McCauley, Interim County Administrator
DATE: February 7, 2022
SUBJECT: Request for Board of County Commissioners approval of an American
Rescue Plan Act (ARPA) grant to Jefferson County Public Utility District
No. 1 (PUD) in the amount of $750,000 to facilitate broadband access to
residents of Jefferson County
STATEMENT OF ISSUE:
The PUD submitted a grant application to the Washington State Broadband Office which, if approved,
would enable the PUD to connect around 650 homes with fiber optic cable. Prior to submitting the grant
application, the PUD was invited to brief the Board of County Commissioners on the grant. During the
briefing the County learned that the PUD was putting up 10% local match. To make the application more
competitive the Board committed $750,000 in ARPA funds to increase the match percentage to 20%
thereby making the grant application much more competitive.
ANALYSIS:
The PUD's grant application was approved in the amount of $9.7 million dollars. Including the local
match, the total project cost is $11.4 million. This will cover the installation of 100 miles of overhead and
underground fiber connecting hundreds of homes in three zones: Cape George Road along Discovery Bay
to Middlepoint Road; Woodland Hills between Highway 19 and Kala Point; and Marrowstone Island.
Now that the state grant has been approved the County and the PUD need to execute a grant agreement
for the $750,000 the Board committed in support of the project. A proposed grant agreement is attached.
FISCAL IMPACT:
$750,000 to be paid out of the Grant Management Fund using ARPA funds.
RECOMMENDATION:
That the Board approve the attached grant agreement with the PUD.
REVIE B :
Date
Mark McCaule , terim County Adminis at
C0N"1'tA9;T IRLMEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Jefferson County Public Utility District No. 1 Contract No: PUD ARPA #2 2-1-22
Contract For: Broadband Grant Match Term: Through December 31, 2022
COUNTY DEPARTMENT: county Administrator
Contact Person: Mark McCauley
Contact Phone: 360-38"130
Contact email: mmccauley@co.jefferson.wa us
AMOUNT: $750,000 PROCESS:
Revenue: N/A
Expenditure:
Matching Funds Required:
Sources(s) of Matching Funds
Fund #
Munis Org/Obj
APPROVAL STEPS:
N/A
N/A
N/A
123
Exempt from Bid Process
Cooperative Purchase
Competitive Sealed Bid
Small Works Roster
Vendor List Bid
RFP or RFQ
Other:
STEP 1: DEPARTMENT CERTIFIES COWLI NCE I 'H C 3. 5.080 AND CHAPT R 2.23 RCW.
CERTIFIED: R N/A: R
gnature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT EEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: N/A:
nature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserf;che):
Electronically approved ,by Risk Management on 2/1/2022.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laseriiche):
Electronically approved as to form by PAO on 2/4/2022.
Standard County ARPA grant language.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
Board of County Commissioners
1820 Jefferson Street
PO Box 1220
Port Townsend, WA 98368
Kate Dean, District 1 Heidi Eisenhour, District 2 Greg Brotherton, District 3
February 16, 2022
Jefferson County Public Utility District No.
Kevin Streett
310 Four Corners Road
Port Townsend, WA 98368
Dear Kevin Streett,
Enclosed for signature are two (2) originals for - AGREEMENT re: American Rescue Plan Act
(ARPA) Grant Match to Facilitate Broadband Access to Residents of Jefferson County; In the
Amount of $750,000: Jefferson County Administrator; Jefferson County Public Utility District
(PUD) No. 1
Please sign both, keep one and return the second along with evidence of coverage of insurance
to:
Jefferson County Commissioner's Office
Attn: Adiel McKnight
P.O. Box 1220
Port Townsend, WA 98368
6. Insurance. Prior to commencing work, the Grantee shall obtain at its own cost and
expense the following insurance coverage specified below and shall keep such coverage in force
during the terms of the Agreement. Commercial Automobile Liability Insurance providing
bodily injury and property damage liability coverage for all owned and non -owned vehicles
assigned to or used in the performance of the work for a combined single limit of not less
than$500,000 each occurrence with the County named as an additional insured in connection
with the Grantee's performance of his Agreement. This insurance shall indicate on the certificate
of insurance the following coverage: (a) Owned automobiles; (b) Hired automobiles; and, (3)
Non -owned automobiles. Commercial General Liability. Insurance in an amount not less than a
single limit of $1,000,000 per occurrence and an aggregate of not less than two (2) times the
occurrence amount ($2,000,000.00 minimum) for bodily injury, including death and property
damage, unless a greater amount is specified in the contract specifications. The commercial
general liability insurance coverage shall contain no limitations on the scope of the protection
provided and include the following minimum coverage
Phone (360) 385-9100 Fax (360) 385-9382 jeffbocc@co.jefferson.wa.us
7. Worker's Compensation (Industrial Insurance).
The Grantee shall maintain workers' compensation insurance at its own expense, as required by
Title 51 RCW, for the term of this Agreement and shall provide evidence of coverage to
Jefferson County Risk Management, upon request
• Payment will be provided upon invoice, subject to the terms of the Agreement.
Thank you for your assistance.
Sincerely,
Adiel McKnight
Executive Assistant
Enclosure: Two (2) original copies for signature
AC40 CERTIFICATE OF LIABILITY INSURANOER 0 12022
F DATE /om"N) D
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT I T QI,��R. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER T I* LICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE E
f W E,Iq1gHORIZED
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REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. (�y�
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endomement(s).
PRODUCER
Pacific Underwriters Corp.
12611 Des Moines Memorial Drive
Seattle, WA 98168
ME:CONTACT Richard Rodruck
PHONE FAX
A/c N xt: 206-248-2254 ac No:206-248-0130
ADDRESS: dick@purms.org
INSURE S AFFORDING COVERAGE
NAIC p
INSURERA: PURMS Self -Insurance Fund
INSURED Public Utility District No. 1 of
INSURER B :
Jefferson County, Washington
INSURERC:
INSURER D :
310 Four Corners Rd.
INSURER E :
Port Townsend, WA 98368
INSURER F :
RnVFRArZ'FS CFRTIFICATF NIIMRFR- 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.
INSR
LTR
TYPE OF INSURANCE
AODL
UBR
POLICY NUMBER
MMIDDIYYYY
MMID IDIYYYY
LIMITS
X
COMMERCIAL GENERALLIABILITY
CLAIMS -MADE OCCUR
PURMS2022L
01/01/2022
12/31/2022
EACH OCCURRENCE
$ 1,000,000
PREMISES (EaoccurrenNTEDce)$
1,000,000
MED EXP (Any one person)
$ 1,500
A
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OPAGG
$ 2,000,000
POLICY E PRO FX] LOC
JECT
$
OTHER:
AUTOMOBILE LIABILITY
PURMS2022LA
01/01/2022
12/31/2022
EaaccdeDSINGLELIMIT
$ 1 000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NONIIED
X HIRED AUTOS FAUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION$
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? F
(Mandatory In NH)
NIA
PURMS 2022WC
01/01/2022
12/31/2022
STATUTE OERH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA E PLOYEE
$ 1,000,000
I E.L. DISEASE - POLICY LIMIT
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Jefferson County, it's elected officials, officers, and employees are named as additional insured under the insurance policies required by the agreement.
rcOTrcv+eTc unr nro CANYtFI I ATInN
Jefferson County
Administrators Office
POLICES BE ELLED
LD
THEUEXANY OF THE ABOVE DESCRIBEDPIRATIION DATE THEREOF, NOTICE I WILL CBECDELIVERED BEFOREDELIVERED
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 1220
AUTHORIZED REPRESENTATIVE
Port Townsend, WA 98368
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ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
ACORIf7�° CERTIFICATE OF LIABILITY INSURANCE
D1A10812022D
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 have ADDITIONAL INSURED provisions or 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
Marsh USA, Inc.
1301 5th Avenue, Suite 1900
Seattle, WA 98101
Attn: Jenelle May, jenelle.may@marsh.com
CONTACT
NAME:
E FAX
PHONN A/C No):
'
E-MAIL
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Everest National Insurance Co
10120
CN 1 03435013--GL XS-22-23 JEFFE
INSURED Public Utility Risk Management Services
INSURER B : Associated Electric & Gas Ins Services Ltd
INSURER C :
Joint Self Insurance Fund
Go Pacific Underwriters
P.O. Box 68787
INSURER D :
INSURER E :
12611 Des Moines Memorial Drive
Seattle, WA 98168
INSURER F
COVERAGES CERTIFICATE NUMRFR- SFA-nnse7.U1n_ni RFVI_CIAN NIIMRFR• 9
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
ADOL
SUBR
POLICYNUMBER
POLICY EFF
MMID
POLICY EXP
MM/D
LIMITS
A
X
COMMERCIALGENERALUABILITY
CLAIMS -MADE X OCCUR
EN4GL00088221
11/01/2022
11/01/2023
EACH OCCURRENCE
$ 5,000,000
DAMAGE T REN E
PREMISES Ea occurrence)
ccurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$ 5,000,000
AGGREGATE LIMIT APPLIES PER:
❑ PR
POLICY O- ❑ LOC
JECT
GENERAL AGGREGATE
$ 5,000,000
GEN'L
X
PRODUCTS - COMP/OP AGG
$ 5,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
J
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
$
1
1
UMBRELLA LIAB
OCCUR
XL5063711P
01/01/2022
01/01/2023
EACH OCCURRENCE
$ 1,000,000
X
EXCESS LIAB
X
CLAIMS -MADE
AGGREGATE
$ 1,000,000
DED I X I RETENTION $1000 000
$
WORKERS COMPENSATION
PER OTH-
I I
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑N
N/A
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Jefferson County Public Utility District No. 1 as Named Insured
Jefferson County is included as additional insured where required by written contract as respects AGREEMENT re: American Rescue Plan Act (ARPA) Grant Match to Facilitate Broadband Access to Residents of
Jefferson County.
Auto Liability is included under the Excess policy shown above subject to $1 M SIR.
Jefferson County Commissioner's Office
Attn: Adiel McKnight
P.O. Box 1220
Port Townsend, WA 98368
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
71ta-%44 7-tSr44 lac.
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD