HomeMy WebLinkAboutWWP273536 (5)ACORD. CERTIFICATE OE LIABILITY INSURANCE 6/30 M/DD/1Y)
06/30/10
PRODUCER 0564249 1-800-833-7337 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Heffernan Insurance Brokers/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Heffernan Professional Practices HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1808 Embarcadero Road, Suite A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Palo Alto, CA 94303
INSURED
Carollo Engineers, A Professional Corporation
10540 Talbert Avenue, Suite 200 East
Fountain Valley, CA 92708
'IKel�1��7•re��9
INSURERS AFFORDING COVERAGE
INSURER A:OneBeacon America Insurance
INSURER B: ACE American Insurance Comp
INSURER D:
INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDffY)
POLICY EXPIRATION
DATE fMMIDDfM
LIMITS
A
GENERAL LIABILITY
7180103170000
12/31/09
12/31/10
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 500,000
X COMMERCIAL GENERAL LIABILITY
—XI
MED EXP (Any one person)
$ 25,000
CLAIMS MADE I OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY X PRO- LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
7180103170000
12/31/09
12/31/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
4060316440000
12/31/09
12/31/10
X ORYTATU- ER -
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
OTHER
B
Professional Liability
G21656495007
07/04/10
07/04/11
Per Claim s1,000,000
Aggregate $2,000,000
Deductible $400,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All operations of the named insured. Re:: Westview Lift Station Final Design & Construction Services Carollo project #:
8235X.00. General Liability Only: Additional Insured endorsement including Primary Non -Contributory wording is
attached. Auto Only: Additional insured endorsement attached.
v 1111-.--. " 1 lve-vet\ I I AUUI IIUNAL INJUKt U; INJUKtK LtI ILK:
City of Renton, Washington
Dave Christensen
Renton City Hall-5th Floor, 1055 S. Grady Way
Renton, WA 98055
I..ANI.CLLJ4 I IUN "iV LAX' NUTIC15 FUR NUN -PAYMENT OF PREMIUM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL INAXPWIMMAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
X0017;!ffi5�74ESX7�C7�[KifRC�KG4Mg:I!t7f7tiF�CAR�74aCK11rJ �:R[M}bsCffiOCX
X&3Wa99W=
AUTHORIZED REPRESENTATIVE 111f /
USA
ftt,UKLJ [5-b (t/Uf) annelza O ACORD CORPORATION 1988
16473622
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
@VANTAGE FOR AUTOMOBILE
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
The following schedule lists the coverage extensions provided by this endorsement. Refer to the. individual provi-
sions to determine the extent of your coverage.
SCHEDULE OF COVERAGE EXTENSIONS
1.
Additional Insured By Contract
11.
Extra Expense — Broadened Coverage
2.
Airbag Discharge
12.
Fellow Employee Exclusion
3.
Auto Theft Reward
13.
Glass Repair — Waiver of Deductible
4.
Blanket Waiver of Subrogation
14.
Hired Auto Physical Damage Coverage
5.
Bodily Injury Redefined — Mental Anguish
15.
Hired Auto — Worldwide Coverage Territory
6.
Broad Form Named Insured
16.
Lease Gap Coverage
7.
Communications Equipment
17.
Liability Coverage — Supplementary Payments
8.
Drive Other Car — Executive Officers
18.
Newly Formed or Acquired Organizations
9.
Duties In The Event of Accident, Claim, Suit or Loss
19.
Physical Damage — Transportation Expenses
10.
Employees As Insureds
20.
Towing — Any Auto
1. ADDITIONAL INSURED BY CONTRACT
The Who Is An Insured provision under SECTION II — LIABILITY COVERAGE is amended to include as Ian
additional insured any person or organization with whom you agreed in a written contract, written agreement or
permit, to provide insurance such as is afforded under this Coverage Form. Such person or organization is an
insured only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part by your
maintenance, operation or use of your covered "autos".
With respect to the insurance afforded to these additional insureds, this insurance does not apply:
a. Unless the written contract or agreement has been executed or the permit has been issued prior to the
"bodily injury" or "property damage";
b. To any person or organization included as an insured by endorsement or in the Declarations, or
c. To any, lessor of "autos" when their contractor agreement with you for such leased "auto" ends.
2. AIRBAG DISCHARGE
If you purchased physical damage coverage for a covered "auto" under this policy, we will pay to reset or re-
place, an airbag that accidentally discharges without the vehicle being involved in an accident. No deductible
applies to this additional coverage. However, this coverage only applies if the airbag is not covered under a
manufacturer's warranty and you did not intentionally cause the airbag to discharge.
3. AUTO THEFT REWARD
We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and con-
viction of anyone stealing a covered "auto". A reward will not be paid to you, a family member, employee or any
public official while performing their duty.
4. BLANKET WAIVER OF SUBROGATION
The Transfer Of Rights Of Recovery Against Others To Us condition under SECTION IV — LOSS CONDI-
TIONS is replaced by the following:
We will waive any right of recovery we may have against any person or organization because of payments we
make for injury or damage arising out of the operation of a covered "auto" when you have assumed liability for
such "bodily injury" or "property damage" under an "insured contract", provided the contract is in writing and
executed prior to the "bodily injury" or "property damage".
5. BODILY INJURY REDEFINED — MENTAL ANGUISH
The definition of "bodily injury" under SECTION V — DEFINITIONS is replaced by the following:
"Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or
death resulting from any of these at any time.
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@@@@@@@@@@@@@@@@@@@@@
6. BROAD FORM NAMED INSURED
a. The Who Is An Insured provision under SECTION II — LIABILITY COVERAGE is amended to include the
following:
Any organization which is a legally incorporated entity in which you own a financial interest of more than
50% of the voting stock on the effective date of this Coverage Form will be a Named Insured until the 180th
day or the end of the policy period whichever comes first, provided there is no other similar insurance avail-
able to that organization.
b. Paragraph a. of this provision 6. does not apply to "bodily injury" or "property damage" for which an
"insured" is also an insured under any other automobile policy or would be an insured under such a policy,
but for its termination or the exhaustion of its limit of insurance.
7. COMMUNICATIONS EQUIPMENT
a. The exclusion for electronic equipment under Exclusions of SECTION III — PHYSICAL DAMAGE COVERAGE
does not apply to loss of any permanently installed, non -removable communications equipment designed
for use as a:
1. Citizen's band radio;
2. Two-way mobile radio or telephone;
3. Scanning monitor receiver, or
4. GPS Navigation System
including its antenna and other accessories.
b. No Deductible applies to this additional coverage.
c. The most we will pay for this coverage is $2,000 per occurrence.
8. DRIVE OTHER CAR— EXECUTIVE OFFICERS
a. The Who Is An Insured provision under SECTION If — LIABILITY COVERAGE is amended to include:
If you are designated in the Declarations as:
1. An individual; you and your spouse.
2. A partnership; your partners and their spouses.
3. An organization other than an individual or a partnership; you "executive officers" and their spouses.
b. SECTION II — LIABILITY COVERAGE and SECTION III — PHYSICAL DAMAGE COVERAGE are extended
to include "autos" you don't own, hire, lease or borrow while in the care, custody or control of an insured
listed in 8.a. This does not include any "auto":
1. Owned by any insured listed in 8.a., or any member of their household, including any such "auto" that is
owned but not insured;
2. Used by an insured listed in 8.a. while working in the business of selling servicing, repairing or parking
autos; or,
3. Insured under another policy of insurance.
If Medical Payments, Uninsured/Underinsured Motorist, Personal Injury Protection or other compulsory
coverages required by the governing jurisdiction are covered on this policy, then insureds listed in 8.a.
above and family members residing in the same households are "insureds" while:
1. Occupying as a passenger, or
2. A pedestrian when struck by
any auto you do not own, hire, lease or borrow, except any auto owned by that insured listed in 8.a, their
family members or an auto insured under any other policy.
c. The limits and deductibles applicable to this provision will be the largest applicable to any owned "auto" for
the specific insurance.
d. The following definition is added to SECTION V — DEFINITIONS of the policy:
."Executive officer" means a.person holding any of the officer positions created by your charter, constitu-
bon, by-laws or any similar governing document.
e. The Other Insurance Condition, under SECTION IV — BUSINESS AUTO CONDITIONS, does not apply to
the provisions of this Drive Other Car endorsement. There is no "other insurance" applicable to this en-
dorsement.
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9. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
Under SECTION IV — BUSINESS AUTO CONDITIONS — the Duties In The Event Of Accident, Claim,
Suit Or Loss Condition is amended as follows:
The requirements that you must
a. notify us of an "accident" claim, "suit" or "loss" and
b. send us documents concerning a claim or "suit"
apply only when such "accident" claim, "suit" or "loss" is known to:
a. You, if you are an individual;
b. A partner, if you are a partnership;
c. An executive officer of the corporation or insurance manager, if you are a corporation; or
d. A manager, if you are a limited liability company.
10. EMPLOYEES AS INSUREDS
The Who Is An Insured provision under SECTION II — LIABILITY COVERAGE is changed by adding the
following:
Any employee of yours while using a covered "auto" you don't own, hire or borrow in your business or
your personal affairs. This coverage is excess over any other collectible insurance.
11. EXTRA EXPENSE— BROADENED COVERAGE
Under Paragraph A. of SECTION III — PHYSICAL DAMAGE COVERAGE, the following Coverage is added:
We will pay for the expense of returning a stolen covered "auto" to you subject to Paragraph C. Limit
Of Insurance.
12. FELLOW EMPLOYEE EXCLUSION
The Fellow Employee exclusion under SECTION II — LIABILITY COVERAGE does not apply if the "bodily
injury" results from the use of a covered "auto" you own or hire. This coverage is excess over any other in-
surance.
13. GLASS REPAIR —WAIVER OF DEDUCTIBLE
Under Paragraph D. Deductible — of SECTION III — PHYSICAL DAMAGE COVERAGE, the following is
added:
No deductible applies to glass damage if the glass is repaired rather than replaced.
14. HIRED AUTO — PHYSICAL DAMAGE COVERAGE
If hired "autos" are covered "autos" under SECTION II — LIABILITY COVERAGE and if Comprehensive,
Specified Causes of Loss, or Collision coverages are provided under this policy for any "auto" you own,
then SECTION III — PHYSICAL DAMAGE COVERAGE is extended to "autos" you hire, subject to the fol-
lowing limit:
The most we will pay for "loss" to any hired "auto" is the lesser of:
a. $50,000,
b. The actual cash value, or
c. The cost of repairing or replacing it with other property of like kind or quality.
The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No
deductible applies to "loss" caused by fire or lightning. Hired Auto Physical Damage coverage is excess
over any other collectible insurance.
Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest
coverage applicable to any covered "auto" you own.
We will also cover loss of use of the hired "auto" if the following conditions are met:
a. it results from an accident,
b. you are legally liable, and
c. the lessor incurs an actual financial loss.
The most we will pay for this loss of use coverage is $1,000 per "accident".
VCA 20102 05 Includes copyrighted material of Insurance Services Office, Inc. Page 3 of 4
Copyright 2004,
15. HIRED AUTO — WORLDWIDE COVERAGE TERRITORY
The definition of coverage territory in General Conditions Policy Period, Coverage Territory — of SEC-
TION IV — BUSINESS AUTO CONDITIONS is amended to add:
Anywhere in the world for autos hired for 30 days or less, provided that any "suit" is brought in the
United States of America (including its territories and possessions), Puerto Rico or Canada.
16. LEASE GAP COVERAGE
Under Paragraph C. Limit of Insurance — of SECTION III PHYSICAL DAMAGE COVERAGE, the follow-
ing is added:
We will also pay the difference between the actual cash value of a covered "auto" at the time of "loss" and
the remaining balance on your lease if the following conditions are met:
a. The "auto" has a long term lease and is covered on this policy.
b. The lessor is added as an Additional Insured in a written lease agreement.
c. You are legally obligated for the remaining balance.
We will. not pay for any amounts representing excess wear and tear charges; additional mileage charges;
taxes; overdue payments; penalties, interest or charges resulting from overdue payments; or lease termina-
tion fees.
17. LIABILITY COVERAGE EXTENSIONS — SUPPLEMENTARY PAYMENTS
Under SECTION II — LIABILITY COVERAGE, the Coverage Extension for Supplementary Payments is re-
vised as follows:
a. The limit for the cost of bail bonds is amended to $3,500.
b. The limit for reasonable expenses incurred by the "insured" is amended to $500 a day.
18. NEWLY FORMED OR ACQUIRED. ORGANIZATIONS
a. The Who Is An Insured provision under SECTION 11— LIABILITY COVERAGE is amended to include
as an "insured" any organization that is formed or acquired by you and over which you maintain majority
ownership.
b. .Paragraph a. of this provision 18. does not apply to any organization:
1. That is a joint venture or partnership,
2. That is an "insured" under any other policy,
3. That has exhausted its Limit of Insurance under any other policy, or
4. 180 days or more after its acquisition or formation by you, unless you have given us notice of the
acquisition or formation.
c. Paragraph a. of this provision 18. does not apply to "bodily injury" or "property damage" that results
from an "accident' that occurred before you formed or acquired the organization.
19. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES COVERAGE
Under SECTION III — PHYSICAL DAMAGE Coverage Extensions, the limit for Transportation Expenses is
amended to $75 per day and the maximum is amended to $1,800.
20. TOWING — COVERED AUTOS
Under SECTION III — PHYSICAL DAMAGE COVERAGE, Coverage for Towing is amended as follows:
a. This coverage applies to any covered "auto" for which a premium charge for towing and labor is shown
in the Schedule or in the Declarations.
b. The limit is $100.
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ADDITIONAL INSURED
This form modifies insurance provided under the following:
GL CONTRACTORS EXTENDER (VCG 206 02 05)
WHO IS AN INSURED — (Section II) is deleted and replaced by the following wording:
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom
you are performing operations when you and such person or organization have agreed in writing in a contract,
agreement or permit that such person or organization be added as an additional insured on your policy. Such person
or organization is an additional insured only with respect to liability for "bodily injury," "property damage" or "personal
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 and completed operations for the additional insured.
The insurance provided to the additional insured is limited as follows:
a) This endorsement shall not increase the limits stated in Section III — LIMITS OF INSURANCE.
b) This insurance does not apply to "bodily injury: or "property damage" caused by "your work" included in the
"products -completed operations hazard" unless you are required to provide such coverage for the additional
insured by a written contract or written agreement in effect during this policy period and signed and executed
by you prior to the loss for which coverage is sought.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or the
.failure to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspections, architectural or engineering activities.
Primary & Non -Contributory: Any coverage provided by this endorsement to an additional insured shall be excess over
any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any
other basis unless a written contract or written agreement in effect during this policy period and signed and executed by
you prior to the loss for which coverage is sought specifically requires that this insurance apply on a primary or
noncontributory basis.
Separation of Insureds: Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in
this Coverage Part to the first Named Insured, this insurance applies:
a. As if each Named Insured were the only Named Insured; and
b. Separately to each insured against whom claim is made or "suit' is brought.
Per Project Aggregate: Under Section III = Limits of Insurance, the General Aggregate Limit applies separately to each
of your projects away from premises owned by or rented to you.
Waiver of Subrogation: Section IV — Transfer of Rights of Recovery Against Others to Us Condition is amended to add
the following: We will waive any right of recovery we may have against any person or organization because of
payments we make for injury or damage arising out of your ongoing operations done under a written contract or
agreement with that person or organization and included in "your work" or the "products -completed operations hazard".
This waiver applies only to persons or organizations with whom you have a written contract executed prior to the "bodily
injury" or "property damage", that requires you to waive your rights of recovery.
Named Insured: Carollo Engineers, A Professional Corporation Policy No.: 7180103170000
Additional
Insured:
Any person or organization with whom you have agreed in written contract, executed prior to loss, to name as
additional insured.
Addendum Number:
to City Clerk Number:
(if applicable).
Contract Class: ❑ Receivable [X—] Payable ❑ Grant ❑ Misc. (no $) Expiration Date:
Contractor Name: Carollo Engineers
Short Description: Consultant Contract for: Westview Lift Station Final Design and Construction Services
Full or Additional
Description:
Legal Review (attach memorandum from City Attorney)
Risk Management review for insurance (attach memorandum from Risk Management)
Insurance certificate and/or policy (attach original)
❑ Response to legal or Risk Management concerns (explain, in writing, how concerns have been met)
❑ Performance bond and verification memo from staff (for Public Works contracts only)
❑ Federal excluded parties list verification (Website: www.epls.gov, attach printout of search results)
❑X City business license number: 030280 Check EDEN or ask Finance Department.
Accounts payable W-9 vendor form (obtain if not already. on file with Finance Dept.)
Submitted contracts are signed by contractor: ❑X Yes ❑ No /f not, provide explanation below.
Fiscal Impact: X❑ Expenditure or ❑ Revenue
Amount Budgeted:
Amount: $ 62,437 (line item; see below*): $ 300,000
Prior Council approval via agenda bill process required if: (see policies 250-02 and 800-12)
Contract or addendum is $20,000 or over (non -Public Works) or $30,000 or over (Public Works).
❑ ' Contract expenditure amount exceeds budgeted amount; fund transfer needed.
❑ Addendum is for the second and additional time extensions.
❑ Interlocal Agreement (most Interlocal Agreements require Resolutions)
Date of Council Approval: Resolution Number: Contractor determined via: ❑ Phone Bid/Written Quote ❑ CFB Ad
(if applicable) (if applicable)
9/21/2009 ❑X Consultant Roster RFP/SOQ Ad ❑ Application ❑ Sole Source
Key words for City Clerk's electronic card file:
Nestview Lift Station, Monterey Avenue NE
Pflnt`:FOrm Revised 07/23/2008
L
ACORD2/17n CERTIFICATE OF LIABILITY INSURANCE M/DD/YY)
12/17/09
PRODUCER 0564249 1-800-833-7337 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Heffernan Insurance Brokers/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Heffernan Professional Practices HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1808 Embarcadero Road, Suite A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Palo Alto, CA 94303
INSURED
Carollo Engineers, A Professional Corporation
10540 Talbert Avenue, Suite 200 East
Fountain Valley, CA 92708
CAVFRAnFR
INSURERS AFFORDING COVERAGE
INSURER A:OneBeacon America insurance
INSURERB:ACE American Insurance Comp
INSURER C:
INSURER D:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
7180103170000
12/31/09
12/31/10
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 500 , 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1K OCCUR
MED EXP (Any one person)
$ 25,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
POLICY X PRO- n LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
7180103170000
12/31/09
12/31/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
OCCUR 171 CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
COMPENSATION AND
WC SLIMIT O R
TATUWORKERS
T RY LIMIT ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
B
OTHER
Professional Liability
G21656495006
07/04/09
07/04/10
Per Claim $1,000,000
Retroactive Date: Unlimited
Aggregate $2,000,000
Deductible $400,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All operations of the named insured. Re:: Westview Lift Station Final Design 6 Construction Services Carollo project #:
8235X.00. General Liability Only: Additional Insured endorsement including Primary Non -Contributory wording is
attached. Auto Only: Additional insured endorsement attached.
GERTIFIGATE HULDEK I I ADDITIONAL INSURED; INSURER LETTER: GANGELL.A I IUN ' IU DAYS NOTICE FOR NON—PAYMENT OF PREMIUM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Renton, Washington DATE THEREOF, THE ISSUING INSURER WILL EXMAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Dave Christensen
Renton City Ball-5th Floor, 1055 S. Grady Way
Renton, WA 98055 AUTHORIZED REPRESENTATIVE
USA
ACORD 25-S (7/97) heffernan
13878659
L
ACORD CORPORATION 1988
Heffernan Insurance Brokers/
Heffernan Professional Practices
1808 Embarcadero Road, Suite A
Palo Alto, CA 94303
USA
City of Renton, Washington
Dave Christensen
Renton City Hall-5th Floor, 1055 S. Grady Way
Renton, WA 98055
USA 0'. 653:653
B`1��X BPO
RECEIVED
DEC 2 2 2009
C1TY OF RENTON
UTILITY SYSTEMS
This document was brought to you by Heffernan Professional Practices and CertificatesNow.
If you have questions regarding this document, please contact the Account Executive at Heffernan
Professional Practices.
Thank you.
MGM
The data included in this notice and in the attached document is confidential to Ebix BPO
and the party responsible for bringing you this information.
1:8
Certificate Delivery by CertificatesNow - www.ConfirmNetcom - 877,669.8600
ADDITIONAL INSURED
This form modifies insurance provided under the following:
GL CONTRACTORS EXTENDER (VCG 206 02 05)
WHO IS AN INSURED — (Section II) is deleted and replaced by the following wording:
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom
you are performing operations when you and such person or organization have agreed in writing in a contract,
agreement or permit that such person or organization be added as an additional insured on your policy. Such person
or organization is an additional insured only with respect to liability for "bodily injury," "property damage" or "personal
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 and completed operations for the additional insured.
The insurance provided to the additional insured is limited as follows:
a) This endorsement shall not increase the limits stated in Section III — LIMITS OF INSURANCE.
b) This insurance does not apply to "bodily injury: or "property damage" caused by "your work" included in the
"products -completed operations hazard" unless you are required to provide such coverage for the additional
insured by a written contract or written agreement in effect during this policy period and signed and executed
by you prior to the loss for which coverage is sought.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspections, architectural or engineering activities.
Primary & Non -Contributory: Any coverage provided by this endorsement to an additional insured shall be excess over
any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any
other basis unless a written contract or written agreement in effect during this policy period and signed and executed by
you prior to the loss for which coverage is sought specifically requires that this insurance apply on a primary or
noncontributory basis.
Separation of Insureds: Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in
this Coverage Part to the first Named Insured, this insurance applies:
a. As if each Named Insured were the only Named Insured; and
b. Separately to each insured against whom claim is made or "suit" is brought.
Per Project Aggregate: Under Section III = Limits of Insurance, the General Aggregate Limit applies separately to each
of your projects away from premises owned by or rented to you.
Waiver of Subrogation: Section IV — Transfer of Rights of Recovery Against Others to Us Condition is amended to add
the following: We will waive any right of recovery we may have against any person or organization because of
payments we make for injury or damage arising out of your ongoing operations done under a written contract or
agreement with that person or organization and included in "your work" or the "products -completed operations hazard".
This waiver applies only to persons or organizations with whom you have a written contract executed prior to the "bodily
injury' or "property damage", that requires you to waive your rights of recovery.
Named Insured: carollo Engineers, A Professional Corporation Policy No.: 7180103170000
Additional
Insured:
Any person or organization with whom you have agreed in written contract, executed prior to loss, to name as
additional insured.
7:8
HUMAN RESOURCES City of
AND RISK MANAGEMENT
M E M O R A N D U M
DATE: September 28, 2009
TO: David Chri tensen
FROM: P.J. Sul
SUBJECT: Insurance Review / Carollo Engineers, P.C.
Westview lift Station
Final Design & Construction Services
I have reviewed the certificate of insurance and supporting policy documents for the
above -mentioned contract. The insurance coverage, evidenced for this contract, meets
the City's risk management requirements.
hArisk\certificates\specific memo's\contract okay.doc
Certificate of Insurance
Agency Name and Address:
Heffernan Insurance Brokers
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1808 Embarcadero Road, Ste. A
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EMEND OR
Palo Alto, CA 94303
ALTER THE COVERAGE AFFORDED THE POLICIES LISTED BELOW.
650 852-5200 Fax 650 852-5201
Insured's Name and Address:
Companies Affording Coverage
CAROLLO ENGINEERS, P.C.
Company -- Ace American Insurance Company
Risk Management Office
NAIC#: 22667 A.M. Best Rating: A+! XV
10540 Talbert Avenue, Suite 200 East
Fountain Valley, CA 92708
COVERAGES: THIS IS TO CERTIFY THAT 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 INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREW IS SUBJECT TO ALL THET.ERMS, EXCLUSIONS. AND CONDITIONS OF SUCH POCtCIES-
CO.
TYPE OF
POLICY
POLICY
POLICY
LTR.
INSURANCE
NUMBER
EFFEC. DATE
EXPIR. DATE
LIMITS
GENERAL LIABILITY
General Aggregate $
[ ] Commt Gen. Liability
Products-Com/O s Agg. $
[ ] Claims Made
Personal & Adv. Injury $
Each Occurrence $
[ ] Occurrence
[ ] Independent Contractors
Fire Damage (any one fire) $
[ ] Contractual
Medical $
BFPD
Other
AUTO LIABILITY
Combined Single Limit $
[ j Any Automobile
[ ] A0 owned autos
Bodily Injury (per person) $
_ _
[ ]Scheduled autos
_
[ ] Hired autos
Bodily Injury (per accident) $
[ j Non -owned autos
[ j Garage Ilabifity
Property Damage $
EXCESS LIABILITY
( j Umbrella Form
Each Occurrence $
Other than Umbrella Form
I Aggregate $
WORKERS'
Statutory Limits:
COMPENSATIONEach
Accident $
AND EMPLOYERS'
Disease -Policy Limit $
LIABILITY
Disease -Each Employee $
A
PROFESSIONAL
13211556495 006
07104/2009
07/0412010
Each Claim $ 11000,000
LIABILITY
Retroactive Date:
Aggregate $ 2,000,000
Unlimited
Deductible $ 400,000
Description
of ODerationS/LOCationrJVehicleslRPetrirlinnc/snarial
if amc-
All operations of the Named_ Insured. Project: Westview Lift Station Final Design & Construction Services
Carollo Project: 8235X.00
important Notice: This certificate does not disclose exclusions, Conditions and other limitations set forth in the policy Itself which may affect the
respective rights and obligations of the Insurer and Policyholder under the policy and may reduce or eliminate coverage for certain losses. The
Policyholder or one or more of Its corporate affiliates being obligated to dfreay or Indirectly reimburse the Insurer for a portion of the losses paid under
the Policy. As a result, the financial cost of a portion of the Insured losses will ultimately be borne by the Policyholder or one or more of its corporate
luaus. anti not ov the Insurer.
Certificate Holder:
ty of Renton, Washington
tvid Christensen
:ntion City Hall N 5th Floor
65 S. Grady Way
xntlon, WA 98055
THE AGGREGATE LIMIT IS THE TOTAL WSURANCE AVAILABLE FOR CLAIMS PRESENTED
WITHIN THE POLICY FOR ALL OPERATIONS OF THE INSURED. CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING OOMPANY WILL MAIL 45 DAYS WRITTEN NOTICE
TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EXCEPT IN THE EVENT OF
CANCELLATION DUE TO NON-PAYMENT OF PREMIUM IN WHICH CASE A 10 DAYS NOTICE
WA.L BE GIVEN.
Date: September 24, 2009
A.CORD�, CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YrM
9/24/2009
PRODUCER Phone: 602-277-6672 - THIS -CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance of AZ, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2800 North Central Avenue, Suite 1600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Phoenix AZ 85004 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE TNAIC It
INSURED _ INSURER A: - ;L• - V 1 Property
Caro
3033 N.
Engineers P.C. 44th S•tre?t, #101 -
INSURERS:Cr at American Insurance Co. 55
033
Phoenix AZ 85018 INSURERC:Farmington Casualty
INSURER D:
INSURERS:
'V V GItAUGA
HE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
InOFINSU
POUCYNUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
A
UMITS
A
X
GENERALUABwrY
6300188B394TIL08 •
12/31/2008
12/31/2009
E+q+OccuIRENcE
$ 1 000 000
X COMMERCIAL GENERAL LIABILITY
P�REMMISES Eaoccurence
$OQ 000
CLAIMS MADE �A I.00CUR
MED EXP(Anyone person)
$20,000
PERSONAL& ADV INJURY
$000
X Cnntrantiial
GENERALAGGREGATE
$10,000,000
GENT AGGREGATE LIMITAPPLIES PEFt
PRODUCTS-COMP/OPAGG
$2 OOO OO
X POLICY JECT LOC
Professional
I Excluded
A
X
AUTOMOBILE LIABILITY
81099SKSOOBTIL08
12/31/2008
12/31/2009
X ANYAUTO
COMBINED SINGLE LIMIT
(EaaccldeM
$1, 000, 000
ALL OWNED AUTOS
BODILYINJURY
$
SCHEDULEDAUTOS
(Perperson)
X
HIREDAUTOS
BODILYINJURY
$ .
X
NON-OMEDAUTOS
(PeraocidenQ
PROPERTYDAMAGE
$
(Peraocberd)
GARAGE LABILITY
AUTOONLY-EAACCIDENT
S
OTHER THAN EAACC
S
ANYAUTO
$
-
AUTO ONLY: AGG
B
EXCESSAIMBRELALIABILITY
TUU5595799
12/31/2008
12/31/2009
EACHOCCURRENCE
$1,000,000
X OCCUR .❑CLAIMS MADE
AGGREGATE
$ 1 00O 00
$
$
DEDUCTIBLE
S
X RETENTION so
C
WORKERS COMPENSATION AND
PFUB995K342108
12/31/2008
12/31/2009
11 TSLAT S I ER
EMPLOYERS' LABILITY
E.L EACH ACCIDENT
$1 00D. O
ANY PROPMETOR/PARTNEMXECUTIVE
E.L. DISEASE -EA EMPLOYEE
S Q
OFFICER/MEMBEREXCLUDED?
Iryes, descrbe under
E.L. DISEASE -POLICY LIMIT
S 1 0 0 a 000
SPECIALPROVISIONsbelow
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS IVEH)CLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Additional Insured and Primary Non -Contributory apply to General Liability, subject to the conditions of the attached
form CGD246 0805. Additional Insured applies to Automobile Liability, subject to the conditions of the attached form
T301 0299. Cancellation applies per attached form ILT354 0398.
e: Westview Lift Station Final Design &Construction Services
arollo project #; 8235X.00
VAIVI,C LLA I IUIV
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
City Of Renton, Washington BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
Dave Christensen WILL MAIL.30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
NAMED TO THE LEFT. (*EXCEPT CANCELLATION FOR NON-PAYMENT OF
Renton City Hall-5th Floor, 1055 S..Grady PREMIUM: 30 DAYS FOR WORKERS COMPENSATION AND 10 DAYS FOR
Way ALL OTHER POLICIES.)
Renton WA 98055
AUTHORIZEDREPRESENTATNE
ACORD 25 (2001/08) n ACORD CORPORATION 1989
IMPORTANT
If the certificate holder, is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a -contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it,
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001f08)
COMMERCIAL GENERAL -LIABILITY
-Policy u: P-630-018813394-TIL-08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDiTIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL P-ENERAL LIABILITY COVERAGE PART
!. WHO IS AN INSURED - (Section 11) is amended
to include any person or organization that ,you
agree in a "written contract requiring insurance"
to include as an additional insured. on this -Cover-
age Part, but:
a) Only with respect to liability for "bodily injury
"property damage" or "personal injury", and
b) If, and only to the extent that, the injury or
damage is caused by acts or omissions of
You or your subcontractor in the performance
...of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does_nnt mimify n. —
insured with respell to the independent acts
or omissions of such person or organization.
2. The insurance provided to tile de additional insure3.
by this endorsement is limited as follows:
a)
b)
In the event that the Limits of insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease the limits of insurance described in
Section III - Limits Of Insurance.
The insurance provided to the additional in-
sured does not apply to "bodily injury", "prop-
erty damage" or "personal injury, arising out
Of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veYing services, including:
i. The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders; or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage caused by "your work"
and included in the "products -completed op-
erations hazard" unless the "written contract
requiring insurance" specifically -requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the -"written contract requiring insur-
ance" requires you to provide such-comerag.e-
or the end of the policy period, whichever is
earlier.
The insurance provided to the additional insured
by this endorsement is excess over any valid and
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that is
available tothe additional insured for a loss we
cover under this endorsement. However, if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis ar a primary and non-contributory basis,
this insurance is' primary to "other insurance"
available to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
••other insurance". But the insurance provided to
the additional insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organization is
an additional insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
CG D2 46. 08 U5 O 2005 The St. Paul Travelers Companies, inc- Page 1 of 2
aaosss g
-COMMERCIAL GENERAL LIABILITY
L How, when and where Abe "occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
L immediately record the specifics of the
claim or "suit" and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit" as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit", cooperate
with us in the investigation -or settlement of
the claim or defense against the "suit", and
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
any provider of "other insurance" which would
cover the additional insured .for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to "other instw
ante" available to the additional insured
which -covets that person or organization as a
named insured as described in paragraph 3.
above.
S. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring insurance" means
that part of any written -contract or agreement
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is -caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
agreement is in effect; and
c. Before the end of the policy period.
Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
POLICY NUMBER,: P-810-99.5K5008-TIL-08 �COMl44t=RCIALAUTO
MSUE .DATE: 12 -16-08
THIS ENDORSEMENT CHANGES THE POD ICE'_ PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
This endorsement modifies insurance provided under the
following:
BUSINESS AUTO COVER{GGE FORM
MOTOR CARRIER COVERAiGE fORIM
TRUCNERS CO VERA-GE fORM
Paragraph-c. of the WHO IS AN INSURED provision
includes the person or organization indicated below,.
f. No liability is assumed by that person or organi-
but only for his, her or its liability because of acts or
omissions "insured"
zation for the payment of an
the policy or earned under the premiums
cy ms staled in
_ of an under paragraphs a. orb. of
that provision, subject to the' following additional pro-
In the event of cancelia#ion of the policy, written
visions:
notice of cancellation will be mailed by us to that
person or organization.
Person or Organization
Address
ANY PERSON OR ORGANIZATION WITH
WHOM YOU HAVE AGREED IN A WRITTEN
CgNTRACT, EXECUTED PRIOR TO LOSS,
TO. NAME, A5 .ADDITIDNAL INSURED.
CA T3 0102 99
Page i of 1
POLICY NUMBER: P-630-01886394-TIL-08
fSSUE.DATE; 12-1-6-08
THIS ENDORSEMENT THE POLICY. PLEASE READ IT CAREFULLY.
. DESIGNATED ENTITY EARLIER NOTICE -OF
CANCELLATION/NONRENEWAL PROVIDED -BY US
:This endorsement modifies insurance provided under the following:
ALL -COVERAGE PARTS INCLUDED IN THIS POLICY
SCHEDULE
-CANCELLATION. Number of Days Notice: 60
WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: ,GO
NAME: AS PER CERTIFICATES ON FILE WITH
TRAVELERS COMiPANY
ADDRESS: .
CA 92708
nonpayment of premium, the number of days re-
quired for notice of cancellation, as provided In
the CONDITIONS Section of this insurance, or as
amended by any applicable state cancellation
endorsement applicable to this insurance, Is in-
creased to the number of days shown in the
SCHEDULE above.
B. For any statutorily permitted reason other than
nonpayment of premium, the number of days re-
quired for notice of When We Do Not Renew
(Nonrenewal), as provided in the CONDITIONS
Section of this insurance, or as amended by any
(Nonrenewal) endorsement applicable to this -In-
surance, is increased to the number of days
shown In the SCHEDULE above.
C_ We will mail notice of cancellation or nonrenewal
or material limitation of those coverage forms to
the person or organization shown In the schedule
above. We will mail the notice at least the Num-
ber of Days Indicated above before the effective
date to our action.
1L T3 54 03 98 .. Copyright, Th.e Travelers Indemnity Company, 1998 Page 1 .of i
010889
POI:avY NUMBER: P-at o-995KSoO8_T <L-os ISSUE DATE: 12-1s-os
THIS. ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED ENTITY -- EARLIER NOTICE OF
CAN CELLATION/NONRENEWAL PROVIDED BY US
T"tnis endorsement modifies insurance provided under the following:
ALLCOI/ERACE PARTS =LUDED IN THIS POLiCY
SCHEDULE
CANCELLATION: Number of.Days Notice:.60
WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: 60
NAME: AS PER CERTIFICATE'S ON FILE WITH
TRAVELERS COMPANY
ADDRESS:
nonpayment of premium, the number ofdays re-
quired for notice of cancellation, as provided in
the CONDITIONS Section of this insurance, or as
amended by any applicable state cancellation
endorsement applicable to this. Insurance, is in-
creased to the number of days shown in the
SCHEDULE above.
B. For any statutorily permitted reason other than
nonpayment of premium, the number of days re-
quired for notice of When We Do Not Renew
(Nonrenewal), as provided in the CONDITIONS
Section of this insurance, or as amended by any
ILT3540398
00SX8
applicable state When We fro Not Renew
(Nonrenewal) endorsement applicable to this in-
surance, is increased to the number of days
shown in the SCHEDULE above.
C. We will mail notice of cancellation or nonrenewal
or material limitation of those coverage forms to
the person or organization shown In the schedule
above. We will mail the notice at least the Num-
ber of Days indicated above before the effective
date to our action.
Copyright, The Travelers. Indemnity Company, 1998.Page 1 of 1
AGENDA BILL SCHEDULE
AGENDA BILL TITLE
PREPARED BY: bmlc y-4-,k-4;e&Extension: '1-D1
6 &4 , V cz--s tit
DEADLINE/DATE
ACTION
110 O
GREGG'S SIGNATURE
R 110
TRANSMIT TO CLERK (Done by Linda M.)
0�
JAY'S AGENDA BILL MEETING: 10 am - 7th floor Council Conf. Rm
COUNCIL MEETING DATE
Referred to Committee
COMMITTEE MEETING DATE (e-mail Committee Report to Teresa who
will final it and send it up to Julia)
COMMITTEE
Time: Place:
COUNCIL MEETING REPORTED OUT
USA\ ] 7Mise \Forms\AB-scheawektP
rA
CITY OF RENTON COUNCIL AGENDA BILL
Al #:
Submitting Data:
For Agenda of:
Dept/Div/Board.. Public Works\Utility Systems
September 21, 2009
Staff Contact...... Dave Christensen, x-7212
Agenda Status
Consent .............. X
Public Hearing..
Subject:
Westview Lift Station Final Design and Construction
Correspondence..
Services Annual Consultant Agreement with Carollo
Ordinance .............
Engineers
Resolution............
Old Business........
New Business.......
Exhibits:
Annual Consultant Agreement
Study Sessions......
Information.........
Recommended Action:
Approvals:
Council Concur
Legal Dept......... X
Finance Dept...... X
Other ...............
Fiscal Impact:
Expenditure Required... $62,437 Transfer/Amendment.......
Amount Budgeted....... $90,000 Revenue Generated.........
Total Project Budget $300,000 City Share Total Project..
SUMMARY OF ACTION:
As part of the 2009 Wastewater Lift Station pre -design effort, a design report that outlined
options for rehabilitation and options for potential gravity replacement was performed for the
Westview Lift Station, including a cost effectiveness analysis. The analysis determined that the
most cost efficient solution, which provided a minimum 20-year extended life for this station,
was to perform a minor rehabilitation to the existing station. This option retains the basic
structural and electrical elements of the station while replacing the majority of mechanical
elements for which we have had issues.
Carollo Engineers was selected from the approved 2009 Utility Systems Annual Consultant
Roster to perform this work. There is sufficient funding for this contract in the 2009 Capital
Improvement Program budget (426/u45479).
STAFF RECOMMENDATION:
Authorize the Mayor and City Clerk to execute the Annual Consultant Agreement with Carollo
Engineers, in the amount of $62,437, for the Westview Lift Station Final Design and Construction
Services Project.
H:\File Sys\WWP - WasteWater\WWP-03-0000 Correspondence - Wastewater\DaveC\2009 Correspondence\Westview Lift Station Design AB.doc\DMCtp
Renton net/agn bill/ bh
CITY OF RENTON COUNCIL AGENDA BILL
Al #:
Submitting Data:
For Agenda of:
Dept/Div/Board.. Public Works\Utility Systems
September 21, 2009
Agenda Status
Staff Contact...... Dave Christensen, x-7212
Consent .............. C. C �NC .
Public Heari OATF..
Subject:
E
Westview Lift Station Final Design and Construction
Correspond nce. AME ' al up
Services Annual Consultant Agreement with Carollo
Ordinance.... -
Engineers
Resolution......... ,
Old Busines ....... F,
Exhibits:
New Business .......... 2-
Annual Consultant Agreement
Study Sessions......
Information.........
Recommended Action:
Approvals:
Council Concur
Legal Dept......... X
Finance Dept...... X
Other ...............
Fiscal Impact:
Expenditure Required... $62,437 Transfer/Amendment.......
Amount Budgeted....... $90,000 Revenue Generated.........
Total Project Budget $300,000 City Share Total Project..
SUMMARY OF ACTION:
As part of the 2009 Wastewater Lift Station pre -design effort, a design report that outlined
options for rehabilitation and options for potential gravity replacement was performed for the
Westview Lift Station, including a cost effectiveness analysis. The analysis determined that the
most cost efficient solution, which provided a minimum 20-year extended life for this station,
was to perform a minor rehabilitation to the existing station. This option retains the basic
structural and electrical elements of the station while replacing the majority of mechanical
elements for which we have had issues.
Carollo Engineers was selected from the approved 2009 Utility Systems Annual Consultant
Roster to perform this work. There is sufficient funding for this contract in the 2009 Capital
Improvement Program budget (426/u45479).
STAFF RECOMMENDATION:
Authorize the Mayor and City Clerk to execute the Annual Consultant Agreement with Carollo
Engineers, in the amount of $62,437, for the Westview Lift Station Final Design and Construction
Services project.
H:\File Sys\WWP - Waste Water\WWP-03-0000 Correspondence - Wastewater\DaveC\2009 Correspondence\Westview Lift Station Design AB.doc\DMCtp
Rentonnet/agnbill/ bh
City of Renton
---
fie• y XFaN.x� �aaeT^"1 �+rb „yi'm7 maob�t' ;'. '.s i y,
P «ner•inSnarq< 9,Project Manager TeaMl<al Advleoro Proje<I Englnear�' Assistant-•?"*
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Westview Lilt Station Rehabilitation
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TASK 1 • Prcl nllnary Design Summary Meting
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TASK2-Design Development
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2.2 :60°/ Des�an Documents
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$261
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$8,216
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$54
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SU rag
'BOK Lin Station Rehab . dOK Force Main Re-routing = 3120,000
Exhibit A
Westview Lift Station
Scope of Services
PROJECT PURPOSE:
This scope of services covers the Phase 2 engineering services associated with performing the
final design and construction services for the selected service alternative for the Westview Lift
Station.
PHASE 2 - FINAL DESIGN AND CONSTRUCTION SERVICES
Phase 2 of the project involves the final design for rehabilitation of the Westview Lift Station as
selected from preliminary design Phase 1. A detailed alternatives analysis was performed in
Phase 1 and it was concluded by the City that the preliminary design for the project had been
adequately completed. The final design phase of this project includes design submittals of 60
percent, 90 percent, and Contract documents, which include plans, specifications, and total
project cost estimate for each submittal. Construction services through completion of the project
are also included in the scope of the project.
TASK 1: PRELIMINARY DESIGN SUMMARY MEETING
Task 1.1 - Project Meeting and Site Visit with City Staff
Conduct a meeting with City staff to discuss the preliminary design Phase 1 selected alternative
Review the proposed scope of services and project schedule, develop a project strategy, and
set key milestone dates. Discuss and identify design criteria and modifications to the selected
alternative. Conduct a site visit with City staff4-aec®ssafy-to discuss preliminary design
recommendations and desired modifications prior to final design.
Task 1 Assumptions: Meeting will occur at City offices.'— �, rl
Task 1 Deliverables: rwV20y"11s}f Meeting Minutes in electronic .pdf file format.
TASK 2: DESIGN DEVELOPMENT
Total tvost30.(i31
The design phase of this project will be accelerated, as preliminary design will be referenced
from the Westview Alternatives Analysis (Carollo, July 2009) completed in Phase 1. Design
submittals for the project will include from 60 percent completion through 100 percent (Contract
document) completion.
Task 2.1 - Design Team Site Visit
Conduct a site visit with the project team prior to starting the final design phase.
Task 2.2 - 60 Percent Desian Documents
Carollo\Documents\Client\WAV2enton\8235X00\Project ManagementTroject Management Plan\WestvieW_Final Design Scope.doc 1
Task 2.3 - 90 Percent Design Documents fit �l-
Task 2.4 - Contract Documents
Develop 60 percent, 90 percent, and Contract design documents for rehabilitation of the
Westview Lift Station. Each design submittal will include technical specification divisions 1
through 17, based on the 17-division CSI format, 11-inch x 17-inch design drawings in AutoCAD
.dwg format, cost estimate detailing total construction cost, and estimated construction
schedule.
The rehabilitation design of the Westview Lift Station will generally consist of the following:
• New concrete valve vault located adjacent to the wet well with new isolation (plug type) and
check valves (swing type), instrumentation connections, and sump pump vault drain back to
the wet well.
• Replace anchors and supports with stainless steel anchors and supports.
• Replace stainless steel discharge piping in wet well, as required.
• Replace pump guide rail system.
• Replace junction boxes with NEMA 4X rated junction boxes located outside of the classified
ventilation area per NFPA 820.
• Replace grinder pumps with similar grinder pumps.
• Relocate float levels and use as backup level measurement system.
• Add submersible transmitter/level transducer and use as primary level measurement
system.
• Modify wet well bottom to create slope as existing conditions allow.
-Re-routing approximately 250 feet of 3-inch diameter force main directly up Monterey Avenue
N.E. to a manhole located in N.E. 12th Street.
Task 2 Assumptions: p : ,w, _ _
Modifications/replacement of the existing control panel is not required. City staff will perform
construction services for re-routing the force main. Maximum of eleven (9) drawings will be
r11 prepared. Specifications will not be provided for the force main installation, only drawing(s).
1. f Contract is based on Engineers Joint Contract Documents Committee (EJCDC). Submission of
i structural calculations is not required. Bid level cost estimate will have an expected accuracy of
plus (+) 15 percent to minus (-) 5 percent. Additional suwey a�449f--geotechnical services are
not required. Cost for additional survey for force main design included.
under- I nd-w4era the fer pe? No easements will be required for project
construction Cost of City applications, forms
or fees not included.
Task 2 Deliverables ;
''"'^F�✓e (25J hard copies and one electronic copy in .pdf file format of
the following:
Carollo\Documents\Client\WAV2enton\8235X00\Project Management\Project Management Plan\Westview_Final Design Scope.do 2
• Task 2.2 - 3-4ard-Gepies-a€ 60 percent drawings 11 "x 17" - and specifications bound
together) cost estimate, and construction schedule.
• Task 2.3 - 90 percent drawings (11 °x 17"} and —specifications bound
together) aad-cost estimate, and construction schedule.
• Task 2.4 - 5 hard copies apd one pdf cep "-Contract drawings
specifications (bound together) and -cost estimate, and construction schedule.
TASK 3: BID PHASE
The objective of this task is to support the City during the bidding process.
Task 3.1 - Respond to Questions and Issue Addenda
Carollo will provide the City with technical support during the bidding period. The City will
respond to questions relating to the contract and any City standards. Carollo will answer%
technical questions pertaining to the design that are forwarded by the City. Any issues requiring
clarification and/or modification will be included in a bid package addendum. `!
Task 3 Assumptions: Maximum of one (1) addendum will be issued. City will coordinate
document distribution and keep track of bid tab.` \
Task 3 Deliverables: Addendum as required, issued in electronic .pdf file format.: i
v �r
TASK 4: CONSTRUCTION PERIOD `? t �i�
{ l �
The objective of this task is to support the City during the construction of the project.
�X r .
Task 4.1 - Submittal Review \Q�' . \ti`'
Carollo will review submittals of a substantially technical nature for conformance with the s'
Contract documents. It is assumed that this effort will include a maximum of six -four total .c v'
submittals/resubmittals. Carollo will provide a written response to each submittal that will
designate the overall submittal as: "No Exceptions Taken", "Make Corrections Noted", "Amender "'
N'\ f
and Resubmit", or "Rejected"- The response will identify the contract requirements associated t✓ . �r�l
with any component that does not comply with the specifications, if applicable.,
Task 4.2 - Request for Information (RFIs)+ ;=\
Carollo will respond to any RFIs forwarded by the City that are of a technical nature and require
the engineer's input. Carollo will provide a written response to each RFI. Responses will be
coordinated with the City. '
Task 4.3 - On -site Assistance h { } ' 'i
Carollo will provide on -site assistance during construction to answer questions or design issues )I
that require field investigation.
+.
Task 4 4 Record DrawAngs \ `l�
Carollo will prepa,rerecord drawings that,reflectjthe ma)orchanges madedunng construction; U
Carollo\Documents\Client\WA\Renton\8235X00\Project Management\Project Management Plan\Westview_Final Design Scope.doc 3
Task 4 Assumptions: Maximum of four (4) submittals1resubmittals required for review for
conformance with the Contract documents. Maximum of two (2) RFIs required during
construction period. Maximum six (6) hours designated for on -site assistance.
Task 4 Deliverables: Submittal and RFI responses will be submitted to the City in
form .pdf file format. Record Drawings::;Two �z�;^fD fu;ro;zu,in+i�la
TASK 5: PROJECT MANAGEMENT
Task 5.1 - Project Management
The objective of this task is to track and execute the project in accordance with the schedule,
budget, and quality expectations that are established. This task includes the following project
management work activities:
• Monitor project progress including work completed, work remaining, budget expended,
schedule, estimated cost of work remaining, and estimated cost at completion-, and manage
activities within total project budget.
• Monitor project activities for potential changes, anticipate changes whenever possible, and
with City approval, modify project tasks, task budgets, and approach to keep the overall _ _...... _
project within budget and on schedule.
• Manage the quality control of all work activities and project deliverables.
Task 5 Assumptions: None. -
Task 5 Deliverables: Scope of services and project budget. Monthly progress report, invoice,
and schedule and written documentation of amendments to the scope of services and
associated budget.
+.:
TASK 6 CONTINGENCY
TotaCost It:,
This task is a placeholderzto allow f6t additional w
ae willeodreknwfithdmd£tuhriencgotnhtrail as tllrected and
by?wpprojectifneeded
Carollo\Documents\Client\WA\Renton\8235X00\Project Management\Project Management Plan\Westview_Final Design Scope.doc 4
David Christensen
From: David Christensen
Sent: Wednesday, August 26, 2009 7:32 AM
To: 'Lars Kammereck'
Subject: RE: Renton Lift Stations
Lara,
I have reviewed the two scopes and have what I believe are just minor amendments at this
time.
For Lake Washington Beach:
Page 2 - Assumptions, Change assumed project length to 18-months. I am basing this off a
estimated start time of October 1, with a controlled construction period being the off -time
for the Park, so, Design Oct 1 thru end of July 2010, bid and Award July/August 2010 and
Construction Sept 2010 thru May 2011. The contract will need a schedule, and as usual, we
will want to keep two. The one in the contract will be very generic and run thru the end of
2011, the one that we will keep at a project level will be closer to the one I just
identified.
Page 4 - Common design Dev Assumptions, first bullet, The City will need three weeks to turn
around reviews.
Page 5, third bullet, Geotech will need to provide minor traffic control as part of drilling
in Park, and contract standard language covers traffic control requirements for contractor.
Page 6 and 7, change deliverable to just two copies, (one for engineering and one for the
shops).
For Westview:
Page 2, Assumptions, change project length to 14-months, Again, assuming beginning on October
1, 2009, with 6-months for design, two months for Bid/Award, and 6 months for construction.
Same type of deal for schedule, go ahead and run schedule to mid 2011 for the contract.
Page 3, Common Design Dev Assump., 4th Bullet, Change to same as Lake Wa Beach.
Page 5, Change deliverables to two, same as Lk Wa Beach.
Page 5 - Assumptions, second bullet, City will locate its utilities and surveyor will call
for locates for remaining private utilities.
This should get them ready for new contracts, each on their own separate contract document.
Let me know if you have any questions, thanks, Dave C.
-----Original Message -----
From: Lara Kammereck [mailto:LKammereck@carollo.com]
Sent: Tuesday, August 25, 2009 9:43 AM
To: David Christensen
Cc: Lara Kammereck
Subject: Renton Lift Stations
Good Morning -
I hope you had a nice week off . The weather was wonderful! I thought about you as I sat in
here working. Looks like it will be nice again for your Friday day of fun....
1
Attached are the revised scopes and budgets for the lift station design and construction
services. Let me know your thoughts. I do have the Word doc of the pre -design contract when
you are ready for me to dump them in.
I need some guidance on ESA's services for East Renton. I am working on their sub agreement,
but I need to figure out how we want to add this to the City/Carollo Agreement. Are you
thinking we should add this scope and increased budget as an amendment? Contractually, we
have fee remaining in Westview and Lakewash Beach we could transfer to East Renton, so we
could add scope and transfer $. or we could decrease current scope to account for the fee
increase?
Look forward to hearing from you-
Lara
Lara Kammereck, P.E.
Carollo Engineers
1218 Third Avenue, Suite 1600
Seattle, WA 98101
P 206-684-6532 C 206-353-2938
F 206-903-0419
I