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Home My WebLink About062810_ca04 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: Frank Gifford, Public Works Director Agenda Date: June 28, 2010 Subject: Contract with Pacific Environmental Services Company Statement of Issue: Contractor will remove material from a small, localized area (approx. 20' X 80') that was previously established adjacent to the closed landfill and will now be remediated (Location map - Contract EXHIBIT B). Contractor selection was through the Small Works process and Pacific Environmental Services Company has been selected as the contractor to perform this work. Analysis/Strategic Goals/Pro's & Con's: This work is mandated by Public Health and will be performed according to regulations prescribed by Public Health and the Department of Ecology. Both Jefferson County Public Health and the Department of Ecology have visited the site, approved our process and approved the testing schedule. Fiscal Impact/Cost Benefit Analysis: This will be a time and materials contract based on an estimate of the work needing to be accomplished (Fee Schedule-Contract EXHIBIT C). The cost is estimated to be $21,405, which will come from the Solid Waste operating budget. Recommendation: Staff recommends approval of the contract with Pacific Environmental Services for the removal of Hazardous Waste materials from the Jefferson County Closed Landfill property. Reviewed By: . /~ // (~/ .;,.r) 2 ~,.:-__; .. . _ .... '-' ,. .:_".c Date /} "/Z P . p Morle~: Crnty Ad/l1j. istrator CONTRACT JEFFERSON COUNTY, WASHINGTON THIS AGREEMENT, made and entered into this day of ,2010, between the COUNTY OF JEFFERSON, acting through the Jefferson County Commissioners and the Director of Public Works under and by virtue of Title 36, RCW, as amended and PACIFIC ENVIRONMENTAL SERVICES COMPANY of PORT TOWNSEND. 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: . Remove hazardous waste materials from a soecific area (see map - Exhibit B) at the Closed Landfill facility and shio for disoosal/incineration. . Test and ship any contaminated soils for orooer disoosal. This contract is based on the Contractor's bid unit pricing for labor, equipment and disposal (Exhibit C), with an estimated total value of Twenty-one Thousand Four Hundred Five Dollars ($21,405). Work will be performed according to the outlined Scope of Work (Exhibit A) and in accordance with Local, State and Federal regulations, 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 within 30 days after receipt of a Notice to Proceed. The Contractor shall provide and bear the expense of all equipment, work and labor of any sort whatsoever that may be required for the transfer of materials and for 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. Insurance ReCluirements 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. Jefferson County and its officers, agents and employees shall be named as additional insured parties on these policies. 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. 3 Revised 10/0512009 pw Jonns\contract\construction contract.doc A. Worker's Compensation and Emplover's Liabilitv Statutory $1,000,000 each accident B. Comprehensive/Commercial General Liabilitv, minimum For bodily injury, death and property damage, with no limitations on the scope of the protection provided, and with the following coverage: 1. Broad Form property damage, no employee exclusion 2. Personal Injury Liability, including extended bodily injury 3. Broad Form Contractual/Commercial Liability 4. Premises - Operations Liability (M & C) 5. Independent Contractors and Subcontractors 6. Blanket Contractual Liability $1,000,000 each occurrence $2,000,000 aggregate C. Truck/Automobile Liability minimum, including pollution endorsement, and with the following coverage: 1. Owned vehicles 2. Non-owned vehicles 3. Leased or Hired vehicles $5,000,000 each occurrence $5,000,000 aggregate D. Contractor's Pollution Liability (or Environmental Pollution Liability) $5,000,000 each occurrence $5,000,000 aggregate E. Environmental Impairment Liability $5,000,000 each occurrence $5,000,000 aggregate 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 Washington State Department of Ecology shall be designated as an express third-party beneficiary in final contract language. No other parties shall be designated as third party beneficiaries. 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 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 to 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. 4 Revised 10/05/2009 pw Jonns\contract\construction contract.doc 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 insurance of the Contractor shall be primary to the insurance of the County. The County reserves the right to request additional insurance on an individual basis for extra hazardous contracts and specific service agreements. 5.' The Contractor shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with the laws of the State of Washington and venue shall be in Jefferson County, W A. 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, in the amount of the estimated contract value, as security for the faithful performance of this contract and for payment of all obligations of The Contractor. 5 Revised 10/05/2009 pw Jonns\contract\construction contract.doc For contracts of$25,000 or less, the County and the Contractor may agree that in-lieu of the Bond; the County will withhold 50% of the Contract amount in accordance with RCW 39.08.010. The Contractor will indicate this option on Exhibit A. 9. The Contractor will declare management option of the statutory retained percentage on Exhibit D. 6 Revised 10/05/2009 pw Jorm s\contract\construction contract.doc 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. Execu!ed by the Contractor b -- / ~ , 2010 Ar/J!=/c ~V~N'.k'l/'!rA47k ~\&'t2G1rc8S C0 ::~~ cJ. c:~ p,4crc E:s Ib~ Ere. State of Washington, Contractor Registration Number COUNTY OF JEFFERSON BOARD OF COMMISSIONERS David W. Sullivan, Chair Phil Johnson, Member John Austin, Member ApH{O~ as to form ~ I )_ this lS:--1Jay of ~ V j\J ~ , 2010 ~l ~~/ Deputy Prosecuting Attorney 6 d(~ Frank Gifford Public Works Director 7 Revised 10/0512009 pw Jonns\contract\construction contract.doc CERTIFICA TION 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 ofthe 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. Y;q.-c I FIC Name of Contractor &//1 A-DN M.l? ~r At.. X'o~ v/c./?S CD C:rR... {hen ;:::k1?S1 Off" ;M/ I 2:> bU/ ~# Cj4lLtA.- C) ( ( Name and Title of Authorized Representative ~~/~ Signature of Authorize Representative D I am unable to certify to the above statement. An explanation is attached. 8 Revised 10/05/2009 pw Jonns\contract\construction contract.doc NOTICE: BIDDERS/CONTRACTORS ARE CAUTIONED TO VERIFY PREVAILING WAGES THIS IS A PREVAILING WAGE RATE CONTRACT UTILIZ ING WASHINGTON STATE WAGE RATES FOR JEFFERSON COUNTY EFFECTIVE MARCH 3, 2010 10 Revised 10/05/2009 pw Jonns\contract\construction contract.doc EXHIBIT A CONTRACT SCOPE OF WORK Contractor will prepare a remediation plan and a safety plan which adheres to all Local, State and Federal safety precautions regarding Hazardous Waste disposal. 2 Contractor will excavate and remove the overburden as directed to remove materials, using equipment as bid. 3 Contractor will locate and remove hazardous material, place in DOT approved shipping containers, and transport to a Department of Ecology approved disposal site immediately after excavation. This is estimated to amount to 1 cubic yard of material. 4 Contractor will remove soil directly surrounding each buried container location, place in DOT approved shipping containers, and transport to a Department of Ecology approved disposal site immediately after excavation. This is estimated to be approximately 10 cubic yards of material. 5 Contractor is responsible for determining approved destination site for disposal and/or incineration. Contractor will prepare a shipping manifest for transporting all materials being hauled to disposal. Manifest must be signed by an authorized County employee. 6 Contractor will perform tests to verify that sufficient additional soil has been removed and there is no remaining contamination. Dependant on test results, contractor has either completed the contract obligation, or may need to remove additional surrounding material. 11 Revised 10/05/2009 pw Jorms\contract\construction contract.doc ..... ~ EXHIBIT B f ~ f f) ! ~I: jj];h~Hf lad HH j~ .n~f~uqn qlnsl o IJI.i: I i .1~ul+I'o~ II _._ ,. ==-,..." "'="'.' ~: .''=':-""!:'''''''-'' ,,,":?-= ,,/ ~ ~ ~ ~ u ~ u ~ ~€ ~ ~ 'S 8- ;:lrt ~= :-E ~ :-;;:: ~ ~j ......?:> s:= = ru ;:$ S 0 ~u ~ a ~ ru ~ ~ 1-4 ,;i !i I, ~ )' co !i .~ II 0 Ii! ~ I' CI) 1'1 __- tt. t t I .-{--- ~ S /: ill ~ I J Ill! 2 II ::1: __ < .I! i iL.:J:;-.-=-' 'f! I ";; ~ i \ IiI t J :1': ~ I \: I;! t! I :o:~ ';;;~ / ., .. I " f p.. E ~ ~ ~ .~~ r.o.. !a o ~ >-u ~2S o~ uCl. a ~ L ~ ~ +- In a ~ Iii ~ ~ ~ ~~ ~~ ~ I ~ j ! ~ ~ 001 If la/i;&a! SoC~ t5 t.: ~. ~~ ~.~ EXHIBIT C PACIFIC ENVIRONMENTAL SERVICES Fee Schedule for Hazmat Removal for Jefferson County Bid Unit Price Estimated Units lotal Hourly labor (includes consultants and/or $4,640.0 subcontractors) $290.00 16 0 Mobilization $200.00 1 $200.00 Daily Equipment Rate $250.00 2 $500.00 Disposal-Incineration $5,294.0 Recovered materials $5,294.00 1 0 $4,250.0 Price per cubic yard for soils $425.00 10 0 $9,544.0 $5,719.00 0 Testing per DOE approved table 1- BlEX and Gasoline By Method NWlPH-Gx/8021B $84.11 5 $420.55 2- BlEX, MTBE and Gasoline By Method 8021B/NWTPH-Cx $95.88 5 $479.40 3- Diesel and Motor Oil Range Organics By Method NWTPH-Ox $80.59 5 $402.95 4- Full Volatile Suite (VOCs) By Method 8260C $160.00 5 $800.00 5- Chlorinated Solvents By Method 8260C $112.94 5 $564.70 $1,323.5 6- Full Semivolatile Suite (SVOCs) By Method 82700 $264.71 5 5 7- low Level Polynuclear Aromatics (PAHs) By Method 82700 SIM $194.12 5 $970.60 8- Polychlorinated Biphenyls (PCBs) By Method 8082 $105.88 5 $529.40 9- RCRA8 + Cu, Ni, Zn By Method 200.8/1631 $194.12 5 $970.60 10- Volatile Sampling Kits for Method 5035A $11.77 5 $58.85 $6,520.6 $1,304.12 0 TOTAL $21,405 13 Revised 10/05/2009 pw Jonns\contract\construction contract.doc EXHIBIT D CONTRACTOR'S DECLARATION OF OPTION FOR MANAGEMENT OF STATUTORY RETAINED PERCENTAGE /-(/ I hereby elect to have the retained percentage of this contract held in a fund by the Owner until (30) days ~wing final acceptance of the work. Date b-/&rO ~~ Si~ned fJ-,,-d'-- ~. . , .4' B. I hereby elect to have the Owner deposit the retained percentage of this contract in an interest bearing account, not subject to withdrawal until after final acceptance of the work. Date Signed C. I hereby elect to have the Owner invest the retained percentage of this contract from time to time as such retained percentage accrues. I hereby designate as the repository for the escrow of said funds. I hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of placing said retained percentage in escrow and investing it as authorized by statute. The Owner shall not be liable in any way for any costs or fees in connection therewith. Date Signed 14 Revised 10/0512009 pw Jonns\contract\construction contract.doc Rax sa't'vex- 611512(),lG .5::58:18. PM PA<JE 2/00,2 Fax Server .~ ACORD' ""'.. ........... ~~. 'PRQQ~ C..>E<R...'T.... '.il':~'I"'A'T: ,E! I!"\....F..... 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'6O:000()() , 6,()00 00.0 A 'lSA'lIQ8583142 UU!Ol'O I/1t26'11 'CQMBJNi:O SINGLE LIMIT (~.'IId::k1ent) $ 1,000,000 agCl,"YINJURY '(t'~rperson) $~ VJN 00 'V4,~,(j4~7',.".~~. .(~) WI..R;€4$7Q9$7' . €C~) Sb:lC4S,;b93j3"~ 111(!'Q~!O itlflOto 11thOl0; tllt2.0H 1/1!2QU '1I1f2011 ~OOoIl.XlNtgRY :,(fier,~rt.) '.'PlttQ~r;~;DAPMGe (p.r~nt) ~VT() ONLY -~A.q;ID~NT q;rHi;:RlfM'N f;A.:*CC AUTO ONLY: AGJl s~ € ~()<)tlZ4~4?~ tlJaq,lQ Itl~{)11 .~ ~ ~. .~. fs~ OQOaOO IS ()()O'OOQ ~ ~ ~ .,:~(>'t~(j~J$ X1:RiH08~$3754 1/tt2QI0 111/Z011 E:LeACHACCIOE E;L,'()IS~ASl;.;.'~'~t:QYEI$.. r;.L,.p~$~-~OUcyL""'lf 00. .......~. sm. <.i..L.'BLlMIT .:..;;;...$.......9'1.:.00....:...'0.)]. '.. OO.l..M. Jl,. \~OHACClDEN'p 3,QOO,000 ,4 3;OQQ,PQU , 3000 000 #e()~Q'2$:(~o.fJ~~) ~~ ':'.:"P'-~, . ,;!):.1l,,~9q~;Ae()~tl'Co'R~ij 'TkA'A~Rn"""'e.,' '.'l'J'r 'oam' ....'.IWt<<l..';lrb;;,bfAC'Q~RD ". ., .~or;ii'~liiJtil".Ji~j~"~;~~,:~nlj<<ib.;.IL~r&'I'tii..tlilI._f.Cll4it..liiAAtli'iailli.,thitcli.ntc.r.' '6RARLHI2'. (f>."'Eill~ ijfpl)~~9FW~'~~~~~I~E:bPf.'>LlClE.$ a~eA~cELLEri. Sa:~t;)RE1HE.E,l(PlRA1"iON PATEtHE.R'EOF~'T8a.iS:suING'Il\lSU9.ERW1tL elmEAvOR lOMAlL.l!L DAYS WRItTeN !~1Jqi:;m.Jf~,~i~{.'"P~~tiQJ;;_'~EDTOlHt:LEFT. "YT Fo\!l;UR:e TO 00 SOSHALL iMPO$BhNO<OBLiGAiiQNOR LtABtlrtYOF ",NY KiND UPON THE If'lSlJRER, ITSAGEN"fS OR MPRESEt.! . ES. :~fl~p~ ACORD Th\ CERTIFICATE OF LIABILITY INSURANCE FAX (425)822-3510 (K) DA TE (MMIODIYYVY) 06/18/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW PRODUCER (425)822-3500 Conover Insurance Agency 11250 Kirkland Way Kirkland, WA 98033 Monica Parks INSURED Pacific Environmental Services Co. PO Box 2049 Port Townsend, WA 98368 INSURERS AFFORDING COVERAGE INSURER A: Evanston Insurance COJ11)any INSURER B: Mutual Of Enumcl aw INSURER c: INSURER D: INSURER E: NAIC# 14761 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING I ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. W~:- ~~~~ TYPE OF INSURANCE POLICY NUMBER P.9L1CY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY 08PKGOO148 09/17/2008 09/17/2010 EACH OCCURRENCE $ 3 , 000 , ooe l- X COMMERCV\L GENERAL LIABILITY DAMAGE Tq~ENTED $ 50, ooe ~:=J. C~IMSMADE []] OCCUR MED EXP (Anyone parson) $ 5,000 A X Poll/Prof Liab-Occ PERSONAL & ADV INJURY $ 3,000,00C ~ $25,000 Deductible , GENERAL AGGREGATE $ 3 , 000 , 000. I-- 3 ,000 , ooe GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ h POLICY m ~~C?T n LOC AUTOMOBILE LIABILITY CPI0053680 09/17/2009 09/17/2010 COMBINED SINGLE LIMIT I- $ X ANY AUTO (Ea accidenQ 1 , 000 , ooe. I- ALL OVVNED AUTOS BODILY INJURY I- (Per person) $ SCHEDULED AUTOS B l- X HIRED AUTOS BODILY INJURY I- (per accident) $ X NON-OVVNED AUTOS I-- I-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRelLA LIABILITY EACH OCCURRENCE $ o OCCUR o CLAIMS MADE AGGREGATE $ $ R DEDUC'SLE $ RETENTION $ $ WORKERS COMPENSATION AND 08PKGOO148 09/17/2008 09/17/2010 I T~$'TfJI~~ I X IOJ~- EMPLOYERS' LIABILITY E,L. EACH ACCIDENT $ 1,000,00C A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WA STOP GAP E,L. DISEASE - EA EMPLOYEE $ 1,000,00e ~P~~I~t~~6~lg16NS below E,L. DISEASE - POLICY LIMIT $ 1,000,00~ OTHER DESCRIPTION OF OPERATIONS I LOCA nONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS tertificate holder is included as an additional insured per attached form IE0036 (0404). CERTIFICA E HOLDER JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS ATTN: JACK REID / SOLID WASTE MANAGER 623 SHERIDAN ST. PORT TOWNSEND, WA 98368 ACORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE lHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -1L DAYS WRittEN NOTICE TO THE CERnFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Br on Ross/KASEYM :Br~ @ACORD CORPORATION 1988