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HomeMy WebLinkAboutWTR2703674—� BUNOC-1 OP ID: GI ACC7RD DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ACT PRODUCER 425-489-4500 NAME' P. 0.Hub International Northwest PH 425-489-4501 WCNNo, Ext: ae,Nol: Bothell, WA 98041-3018 E-MAIL Jenny Landers ADDRESS: INSURED Buno Construction LLC 20219 99th Ave SE Snohomish, WA 98290 INSURER(S)AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Co. 25658 INSURER B : The Charter Oak Fire Ins Co Travelers PropAmerPCCo. of A INSURER C : 25674 INSURER D : INSURER E : INSURER F : CnVCRAf_FC rFRTIFIRATF NIIMRFR• RFVISIAN NIIMRFR- 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 B POLICY NUMBER MMIDPOLIO EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,00 DAMAGE TO RENTED PREMISES IF. occurrence $ 300,000 A X COMMERCIAL GENERAL LIABILITY DTC0527D29651ND14 06/06/74 06/06/15 CLAIMS -MADE rx-1 OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 X STOPGAP LIAB. GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,00 POLICY PRO X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000 000 $ r BODILY INJURY (Per person) $ B X ANY AUTO BA527D2965CNS14 06/06/14 06/06/15 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOAUTOS X HIR DSAUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 C EXCESS LIAR CLAIMS -MADE DTSMCUP527D2965TIL14 06/06/14 06/06/15 DED I X I RETENTION$ 10,000 $ N / A DTC0527D29651ND14 WASHINGTON STOP GAP A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) 06/06/14 06/06/15 WCSTATU X OTH- T Y LIMITS E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT: CITY OF RENTON, AND ITS OFFICERS, OFFICIALS, AGENTS, EMPLOYEES, AND VOLUNTEERS. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY. PER PROJECT AGGREGATE AND WAIVER OF SUBROGATION APPLY. SEE ATTACHED ENDORSEMENTS. RE: MONTEREY TERRACE WATER MAIN REPLACEMENT, CAG-14-018. rFRT11=1r ATP: uni nPP rANrFI I OTION CITYOFR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF RENTON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 MILL AVENUE S. RENTON, WA 98055 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN A WRITTEN CONTRACT WHICH IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C. regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". Designated Project General Aggregate(s): GENERAL AGGREGATE LIMIT SHOWN ON THE DECLARATIONS. 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III —LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from 'occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 5k Ell let! 421, T O`ygV ppV "EE 4 R.-v" tip Ebm 2�2��' ��•'Pi 0.� 4 �� N Z`�`� er � � Zp IN �G ?I HIS! ca m > 29 i it oils p a 9C Q m 3 C sic,.� G y9 89 y »4 E Net M III HM Q Pu. W ; `P 4?g$ s• S£ 2�h Rh N. -$o }yS�{^pc +�4 RrYy,i {j(�1aY l2a3yzg p.clnC1DryMINIM p nw .51hava Mud » alit!r� Z � 5���,�a�•f.�m Cp�b-Stl3��pB �Aa{..��Q�C3� �w �m�• E .Cp ���p11Ij pG yy � �p ,1y 0 (g� spy pyx 1q I� 6 1 .� '^� ✓W� z W. �5 K a r m cl s " 1011 ,=1 1s ; 2.1 te r ti/ II ; � � �. ii � ('%aYi� tl ��r,ds•.tl ,$ � n °N C ii}.0 ���Cgg � �` C� ��i@$Pi% m ssoo ,n pp j i5pp R.t� zp�not � A . Sj = - Wpm' {s»s.. A ° zn '.eaH,4x am-Sg 5m- i%"'y. m c COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement bruadens coverage. However, coverage for any injury, damage or medical expenses described In any of the previsions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. Increased Supplementary Payments 0, Incidental Medical Malpractice E. Who Is An Insured - Newly Acquired Or Formed Organizations F. Who Is An Insured - Broadened Named insured - Unnamed Subsidiaries G. Blanket Additional Insured - Owners. Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft. Auto Or Watercraft, in Paragraph 2. of SECTION I - COVERAGES - COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is. (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop. erty for a Charge B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion I., Damage To Property. in Para- graph 2. of SECTION I - COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY Is deieled. 2. The following replaces the last paragraph of Paragraph 2.. Exclusions. of SECTION I - COVERAGES - COVERAGE A. BODILY H. Blanket Additional insured - Lessors Of Leased Equipment 1, Blanket Additional Insured - States Or Political Subdivisions - Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogation W Amended Bodily Injury Definition N. Contractual Liability- Railroads INJURY AND PROPERTY DAMAGE Lb - ABILITY Exclusions c. and g. through n. do not apply to -promises damage". Exclusion U(1)(a) does not apply to "Premises damage" caused by' a, Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fie, explosion, or lghtning; or a. Water. unless Exclusion f. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion - All Pollu- tion Injury Or Damage or Total Pollution Ex. clusion m its title. A separate limit of insurance applies to "premises damage" as described in Para- graph 6. of SECTION III - LIMITS OF IN- SURANCE COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC. TION III - LIMITS OF INSURANCE: Subject to S. above. the Damage To Prom. ises Rented To You Limitis the most we will pay under Coverage A for damages because of "premises damage" to any one premises The Damage To Premises Rented To You Limit cola apply to all "property damage" proximately caused by the same 'occur- rence', whether such damage results from. fire; explosion. lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Promises Rented To You Limit wilt bw a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Pan, or b- $300.000 it no amount is shown for the Damage To Premises Rented To You Limit can the Declarations of this Coverage Pan 4. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease of promises. How- ever, that portion of the contract for a lease of promises that Indemnifies any person of organization for "premises damage" is not an "insured contract"; 5. The following is added to the DEFINITIONS Section. 'Premises damage" means "property dam- age- tea: a. Any promises while rented to you or tem- peuardy occupied by you with pomalssion of the owner; or tb_ The contents of any premises while such premises is rented to you, it you rent such premises for a period of seven or fewer consecutive days. 6. The tofiowimg replaces Paragraph 4.b.(1)(b) of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS (b) Thal is insurance for -premises damage or I. Paragraph 4.b.(1)(c) of SECTION IV - COMMERCIAL GENERAL LIABILITY CON. DITIONS is deieted- C. INCREASED SUPPLEMENTARY PAYMENTS 1. The IrAowmg replaces Paragraph 1.b. ui SUPPLEMENTARY PAYMENTS - COVER- AGES A AND B of SECTION I - COVER. AGE. b. Up to $2.50U for the cost of bai bonds required because of accidents or traffic law vtolabons ansing out of the use of any vehicle to which the Bodily injury Liability Coverage applies. We do not have to fur- nish these bonds 2. The following replaces Paragraph 1.d, of SUPPLEMENTARY PAYMENTS - COVER- AGES A AND B of SECTION I - COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit". Including actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" In the DEFINITIONS Section "Occurrence" also means an act or omission committed in providing or failing to provide 'incidental medical services", first aid or "Good Samaritan services" to a person. 2, The following is added to Paragraph 2A,(i) of SECTION Il - WHO 18 AN INSURED. Paragraph (1)(d) above does not apply to "bodily injury" ansing out of providing or fail. ing to provide: (I) "Incidentat medical services" by any of your "employees" who is a nurse pracll- tioner, registered nurse., licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (it) First aid or "Good Samaritan services' by any of your 'employees" or "volunteer workars' other than an employed or vot- unteer doctor. Any such "employees" or 'volunteer workers' providing or failing to provide first aid or "Good Samaritan ser vices" during their work hours for you will be deemed to be acting within Ole scope of their employment by you or performing duties related to the conduct of your busi- ness. CG 03 16 11 It .,., . . ..,arar 1111 c Page t of 6 Page 2 of I .-. .mr,.�.-, . s .. .;�."es It 11 11 3. The tottomng is added to Paragraph 5, of SECTION IN - LIMITS OF INSURANCE. For the purposes of datermimnig the applica- ble Eactt Occurrence Limit. all related acts of omissions committed in providing or failing to provide 'incidental medical services', first aid or *Good Samaritan xervicos' to any one per- son will be deemed to be one 'occurrence". 4- 'rho following exclusion is added to Para- graph 2., Exclusions. of SECTION I - COV- ERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals 'Bodily injury,. or „property damage' arising out of the willful violation of a penal statute or ordinance rekrling to the safe Lit pharmaccuo- cats commitfed by, or with file knowledge or consent Of. the M.;;,cd. S. The following is added to the DEFINITIONS Section: "Incidental modmat services' means, a. Medical, surgical, demo!. laboratoey, x-ray or nursing sr3rv" or treatment, advice or instruction. or the related furnishing of food or beverages, of IS. rn. The feshing of dispenwrig of drugs or medical, denlai. or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medicar services for which no compen- sa£ion is demanded or received. 6. The following is added to Paragraph 4.b.. Ex- cess Insurance. of SECTION IV - COM- MERCIAL GENERAL LIABILITY CONDI- TIONS The insurance i5 excess ovC'r any valid and collectible other insurance available to the in- sured< whether primary. excess. contingent or on any other basis, that Is available to any of your 'employees' or 'volunteer workers' for "bodify injury' that arises out of providing or failing to provide 'incjdontal medical scr- vices'. first aid or "Good Samaritan services' to any person to the extent not subject to Paragraph 2A,(1) of Section It - INhd Is An Insured. E. WHO IS AN INSURED - NEWLY ACQUIRED OR FORMED ORGANIZATIONS The foNowmg replaces Paragraph 4. of SECTION If - WHO 13 AN INSURED, COMMERCIAL GENERAL LIABILITY 4. Any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company. of which you are the sofa owner or In which you maintain the ma- jority ownership Interest, will qualify as a Named Insured it there is no other insurance which provides similar coverage to that or- ganization. Hoiivever: a. Coverage under this provision is afforded only: (1) Until the 18M day after you acquire or form the organization or the end of the policy period whichever is earlier. if you do not report such organization in writing to us within 180 days after you acquire or form n: or (2) Until the end of the policy period, when that date is later than 1W days after you acquire or form such organization. If you report such organization in writing to us whin 180 days after you acquire or (arm it. and we agree in writing that it will con- tinue to be a Named Insured until the ono of the policy period; b. Coverage A does not apply to 'bodily injury" or "properly damage' that occuned before you acquired or formed the organization; and c. Coverage B does not apply to 'personal In- jury" or "advertising injury' arising out of an offense committed before you acquired or formed the organization WHO IS AN INSURED - BROADENED NAMED INSURED - UNNAMED SUBSIDIARIES The following Is added to SECTION If - WHO IS AN INSURED. Any of your subsidiaries, other then a partnership. Taint venture or limited liability company, his£ is not shown as a Named Insured in the Declara- tions is a Named insured if you maintain an own. arship interest of more than 50% in such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed after the date, If any, during the policy period. that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. COMMERCIAL GENERAL LIABILITY BLANKET ADDITIONAL INSURED - OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION 11 - WHO IS AN INSURED Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in - crude as an additional insured on this Coverage Part is an insured, but only with respect to liability for 'bodily injury", "property damage", "personal Injury" or "advertising injury" that: a. Is "bodily Injuryy' or "properly damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit - tad, subsequent to the execution of that con- tract or agreement: and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such promises owner, manager or lessor is subject to the following Pro. visions; a. The limits of insurance provided to such prerrases owner, manager or lessor will be The minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less. b. The insurance provided to such promises. owner, manager or lessor doesnot apply to: (1) Any 'bodily injury" or "property damage" that occurs, or "personal injury" or "advef- tisvng injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, now construction or demos#ion operations performed by or on behalf of such promises owner, lessor or manager. c. The 'insurance provided to such premises owner, manager or lessor Is excess over any valid and collectible other insurance available to such promises owner. managers or lessor. whether primary, excess. contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary lo. or non- contributory with, such other insurance., in which case this insurance will be primary to, and non-contributory with, such other insur+ ante H. BLANKET ADDITIONAL INSURED - LESSORS OF LEASED EQUIPMENT The following =s added to SECTION 11 - WHO IS AN INSURED Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an Insured on this Coverage Part is an insured, but only with M, spect to liability for "bodily injury", "Property dam - ago", "personal injury" or "advonising injury" that: a. Is "testily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is Commit- ted, subsequent to the execution of that con- tractor agreement. and b. Is caused, In whole or in pan, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions. a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide In the written contract or agreement, or the limits shown on the Declarations, whichever are less. b, The insurance provided to such equipmaltl lessor does not apply to any 'bodily injury' or 'property damage" that occurs. or "personal injury" or "advertising injury" caused by an of- fense that is committed, attar the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other oasis. unless you have agreed in the written contract or agreement that this insurance must be primary to, or non-contrbutory with, Sven other insurance. In which case this insurance will be primary to, and non.connbutory with, such other in- surance. I. BLANKET ADDITIONAL INSURED - STATES OR POLITICAL SUBDIVISIONS- PERMITS The following, Is added to SECTION II - WHO IS ANINSURED Any state of political subdivision that has issued a permit in connection with operations peR,ormed by you or on your behalf and that you are required CG D3 16 11 11 c: cc't *re',r eers *1,de>* :t, »umDB r A° srervea Page 3 of 6 Page 4 of 6 Y; zee 1 Ira "—we's .140 er G<�wanr as CG 03 1611 It Y w ° E m oLa � w a m z r y > a Psi mm a o w N�G� _ o tim o i7 w ngw m n, O ell ey 4 �• - �S a Om tad 210 e � u° LU i ® 12 rn d a S g g ° "¢$ m a � w na 5 3 a£ o o s� c g m a � a� t z E m� � "qEr _a c-F�di' m �aC 3w.hg$�vacaw. wb��£'� •§o mW oao££o, La 4i ta,� > g g 6$ �c w -a 0 SY 9 0 01? `°g E � � �v 4 ootw b £' a' > �i ... w 'G w u �n w = O rn a $ . a r- W. u@ma y mn = vi C aG 3 c aUZav'4g7Ica�� �rd9roses i w oc owEor2�q °V�w a my S $ac2 mct� (J.7 a sa w �.- '£' $ a a Q Sr O 2- c.. k .. m gy!ww �+ m 'a%r 'awe oZOO " m 3° 0 Qd o,$_y.m „' q� ., n g it c~3 paa� ° q> W £ m Ey M w y W in a w d G a g e1. •S — g. 0 V W C a C i�i.' 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'f 0w. 0 O a Contract Number: (assigned by City Clerk) Select Type: ❑X Contract/Agr. ❑ Permit Staff Name: Andrew ❑ Lease ❑ Adden/Change O Extension: 72nR Contract Type: (assigned by City Clerk) Department/Division: Utility Systems Division - Water Utility EDEN Queue: Addenda/CO #: to City Clerk's CAG #: 05-007P (if applicable) Expiration Date: 05/01/2015 Contract Class: ❑ Receivable 0 Payable ❑ Grant ❑ Misc. (no $) Contractor Name: Buno Construction, LLC Contract Solicitation Method: Formal Call for Bid (CFB) Advertised via City Clerk Short Description: Monterey Terrace Water Main Replacement. 8" and 12" water main replacement. Full or Additional Monterey Terrace Water Main Replacement. 4,100LF (combined) 8" and 12" water main construction to Description: replace old water mains and improve fire flow. ❑ Legal Review (attach memorandum from City Attorney) 0 Risk Management review for insurance (attach memorandum from Risk Management) 0 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 type of contracts $35k & over only) 0 Federal excluded parties list verification (Attach printout of search results from Website: www.sam.gov/portal/public/SAM) Active business license and Accounts payable W-9 vendor form? (obtain if not already on file with Finance Dept.) 0 Yes ❑ No Submitted contracts are signed by contractor? If "No'; provide explanation here: Fiscal Impact to City: FX� Expenditure OR ❑ Revenue Amount Budgeted: (line item; see below),.$1,100,000.00 Amount of Attached (including tax) $ 775,073.85 per year for 1 years = Total Amount of Attached $ 775,073.85 Prior Council approval via agenda bill process required if: (see policy250-02) Contract or addendum is $100k or over (non -Public Works) or $150k or over (Public Works). ❑ Budget adjustment or fund transfer is necessary. ❑ Interlocal Agreement (most Interlocal Agreements require Resolutions) Date of Council Approval: Resolution Number: NOTE: Mayor signs for the City, except that the Department Head may sign contracts: ►f applicable) ►f a Under $35,000 when for non -Public Works & Small Public Works Roster (SWR); ( pP ( applicable) Under $40,000 when for Public Works single craft non-SWR; and Under $65,000 when for Public Works multi -craft non SWR EXCEPT: Change Orders to PW contracts in any amount can be signed by Project Mgr IF 4/7/2014 within budget AND under Administrator's authorization. Key words for City Clerk's electronic card file: Monterey Terrace Water, Monterey Drive NE, Monterey Place NE, Capri Ave NE, Monterey Water Print Form Revised 10/25/2013 Award Date: Awarded to: Award Amount: CAG-14-018. Bidding Requirements, City of Renton Forms, Contract Forms, Conditions of the Contract, Plans and Specifications Construction of: Monterey Terrace Water Main Replacement Project PROJECT NO. WTR-27-3674 February 2014 City of Renton 1055 South Grady Way Renton, WA 98057 Project Manager: Andrew Weygandt, PE, (425) 430-7208 City of Page 1 Cover Page Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www,bxwa.com - Always Verify Scale STATE OF WASHINGTON County of ss ) INDIVIDUAL FORM On this day of before me personally appeared to me known to be the individual(s) described in and who executed the foregoing instrument, and acknowledged under oath that (he/she/they) signed and sealed the same as (his, her, their) free and voluntary act and deed, for the uses and purposes therein mentioned. GIVEN under my hand and official seal the day and year last above written. (SEAL) STATE OF WASHINGTON ss County of Notary Public in and for the State of Washington, residing at Print Name: My commission expires: CORPORATION FORM On this day of before me personally appeared to me known to be the (President, Secretary, Treasurer) of the corporation that executed the foregoing instrument, and acknowledged said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that (he/she/they) are authorized to execute said instrument. GIVEN under my hand and official seal the day and year last above written. (SEAL) Notary Public in and for the State of Washington, residing at Print Name: My commission expires: Proposal & Affidavit/Certificate - Page 3 of 4 08 COMBINED PROP and TRIPLE FORM W-3674.doc Page 14 Individual Form Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale City of Renton Monterey Terrace Water Main Replacement Project Addendum No.1 Issued: 02 212014 Page 1 of 2 City of Kenton Monterey Terrace Water Main Replacement Project A oZ 6 a wm ++ t WTR-27-3674 ADDENDUM NO. 1 Issued: February 21, 2014 To All Contract Document Holders: You are hereby notified of the following changes, deletions, additions, corrections and clarifications to the plans, specifications and other documents comprising the Contract Documents for the City of Renton, Monterey Terrace Water Main Replacement Project. Schedule of Prices The bid quantity shown for Item 18. Connection to Existing Water Main — NE Jd Street should be revised from 8 to 1. The bid quantity for Item 19. Connection to Existing Water Main — Monterey PI NE should be re%rised from 8 to 1. Clarification Per City of Renton Standard Plan 300.0, Note ##4, included in the Standard Plans section: "...fittings shall be Class 250 as per ANSI/AWWA C110/A.21.10-82." The City of Renton Water Utility will accept AWWA C153 fitting End revisions for Addendum No. I HAFile Sys\WTR - Drinking Water Ut11A1 WTR-27 - Water Project Files\WTR27.3674 Monterey Terrace Water Main ReAlacementkConlract Documents'Addendum No t .doc Pagel Addendum #1 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale City of Renton Monterey Terrace Water Main Replacement Project Addendum No.1 Issued; 02 21/2014 Page 2 of 2 Addendum No. 1 is hereby made a part of the Contract Documents, and its terms and conditions are fully binding on the Contract Document holder. He/she shall acknowledge receipt of Addendum No. 1 by signing in the space pro -.Tided below and attaching it to his/her proposal. This Addendum No. 1 must be acknowledged in the bid. CITY OF RENTON Andrew Weygandt, Project Manager Issued Februw 21, 2014 Received and Acknowledged; Company Name Signature of person receiving addendum MQOA"lei Tile Date HAFile Sys%WTR - Drinking Water UUIIty1WTR-27 - Water Project Files%WTR-27-3674 Monterey Te ace Water Main Repiacomont%Conract QocumenWAddendum No t.doc Page 2 Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scale BOUNO OWNER CONSTRUCTION, LLC. COMPLETED PROTECTS PROJECT CONTACT AMOUNT DESCRIPTION City Of Shelton Basin 5 Sewer City Of Shelton $8,850,000.00 27,000 LF Of 8" thru 18" PVC Sewer 525 West Cota Street Rehabilitation Prject Att: Jerry Hauth Main W/30,000 LF of 4" thru 6" Side Shelton WA 98584 (360) 432-5120 Sewer Pipe From Main to House,14,000 LF of 6 thru 15" CIPP, IEA Lift Station & +/- 7,000 LF of Roadway Reconstruction Highline Water District S.182nd Street Highline Water District $184,000.00 Construct 1,300 LF Of 8"& 4" DI 23828 30th Ave S Water Main Att: Jeremy Delmar Water Main & Associated Appurtenances Kent WA 98032 Replacement (206) 824-0375 Cross Valley Water District SR 9 212th to 176th Penhallegon Associates $2,135,000.00 12,000 LF Of 12" 8" & 6" 8802180th St SE Water Main Relocations Dave Hutley DI Water Main W/ 4EA Jack & Bores, Snohomish Wa 982% (425) 827-2014 2EA Directional Drills &Appurtenances City Of Auburn Lakeland Hills City Of Auburn $1,965,000.00 Construct Booster Pump Station to 25 West Main Street Booster Pump Station Att Ryan Vondrak include on & off site piping, 24" header w/ Auburn WA 98001 (253) 931-3086 pump cans and masonry block structure Ronald Wastewater District Echo Cove CHS Engineers $420,000.00 Construct 840 LF of 18" DI Sewer 17505 Linden Ave North Bypass Att: Scott Christianson Main to include manholes at depths Shoreline WA 98133 (425) 637-3693 up to 25 feet Northshore Utility District 116/98 Northshore Utility Dist. $1,090,000.00 Construct 5,100 LF of 8" & 12" DI 6830 NE 185th Street Water Main Att Stephen Dennehy Watermain on arterial street to PO Box 82489 Replacement Project (425) 398-4405 include water sevices, fire hydrants, Kenmore WA 98028 asphalt and landscape restoration. Highline Water District 490 Zone Highline Water District $2,980,000.00 Construct 19,700 LF Of 12" thru 4" DI 23828 30th Ave S Water System Att Jeremy Delmar Water Main to include Rehab of an existing Kent WA 98032 Improvements (206) 824-0375 Pump Station & Roadway Restoration. Northshore Utility District Lift Station # 14 Northshore Utility Dist. $1,200,000.00 Complete Removal & Replacement 6830 NE 185th Street Replacement Att: Stephen Dennehy of existing 450 GPM Sewer Lift Station PO Box 82489 (425) 398-4405 To include Conc/Masonry Building, Kenmore WA 98028 Electrical, Genset & Long Term Bypass with Backup System. Chelan County PUD # 1 Monitor Water System Chelan County PUD $3,445,350.00 Construct 41,000 LF of 8" thru 12" DI 327 North Wenatchee Avenue Att John Goodwill Watennain to include RR Crossing by PO Box 1231 (509) 661-4022 Pipe Ramming and Bridge Crossing of Wenatchee WA 98801 Att. Vern Chamberlain 12" DI w/Insulation across Monitor (509) 661-4680 Bridge. W/159 Services & Restoration City Of Oak Harbor Scenic Heights Lift City Of Oak Harbor $1,200,000.00 Construct Lift Station, Gravity Sewer, 865 Barrington Drive Station & Sewer Att: Russ Parbarcus Force Main To Include Street Restoration. Oak harbor WA 98277 Improvements (360) 679-5551 City Of Carnation Side Sewer Installations Roth Hill Engineers $1,975,000.00 Construct +/- 270 Side Sewers from 4621 Tolt Avenue Att: Laurie Fulton ROW To House To Complete the Sewer PO Box 1238 (425) 869-9448 System For The City. All Sewers Were Carnation WA 98014 City Of Carnation Att Candice Bock Open Cut. This Work Included (425) 333-4192 Restoration Following Close Behind. City Of Carnation Sewer -Vacuum Vanir Construction Mg. $7,800,000.00 Complete Installation of Vacuum Sewer 4621 Tolt Avenue Collection System Att Tim Clark System to include 56,600 LF of 4" Thru PO Box 1238 (425) 577-0095 12" Vacuum Sewer Pipe, 4,600 LF Of 12" Carnation WA 98014 City Of Carnation Att: Candice Bock HDPE Force Main & 15,000 LF Of 6" (425) 333-4192 Gravity Laterals w/Appurt.& Restoration Skyway Water & Sewer District Seelye Addition Skyway W & S District $5,100,000.00 13,500 LF Of 8" thru 15" PVC Sewer 11909 Renton Ave South Sewer Improvements Att: Cheryl Schuarman Main W/22,400 LF of 4" thru 6" Side Seattle WA 98178 (206) 772-7343 Sewer Pipe From Main to House To Include Street & Roadway Restoration Soos Creek Wtr & Swr District Panther Lake NE Roth Hill Engineering $200,000.00 1,610 LF Of 8" PVC Sewer Main 14616 SE 192nd Street Trunk Sewer Att Katherine Maxwell Adjacent to sensitive Wetland and Renton WA 98059 (425) 869-9448 Through Wetland Buffer Areas Northshore Utility District Inglemoor Tank Farm Northshore Utility Dist. $900,000.00 Replace 24" Inlet -Outlet Piping ® (3) 6830 NE 185th Street Site Piping Att Steve Dennehey Tanks W/ The Demolition Of Site Piping Kenmore WA 98028 Alterations (425) 398-4400 & Replacement W/ 30" & 24" DI Pipe. King County Water District # 85 2002 Water Main Penhallegon Associates $1,378,500.00 17,700 LF Of 8" 2108 SW 146th Street Replacement Project Bob Stanton DI Water Main W/ Seahurst WA 98062 Phase 1 & 2 (425) 827-2014 Appurtenances Woodinville Water District AC Water Main CHS Engineers $270,000.00 Z700 LF Of 8" 17238 Woodinville - Duvall Rd Replacement Att: Mary Dahl DI Water Main W/ Woodinville WA 98072 Schedule 9 (425) 637-3693 Appurtenances Cross Valley Water District Clearview Local Facilities Penhallegon Associates $780,000.00 6,700 LF Of 24" & 18" 8802180th St. SE Transmission Main Dave Hutley DI Water Main W/ Snohomish Wa 98296 (425) 827-2014 Appurtenances Northshore Utility District Totem Lake Fire Flow Northshore Utility Dist. $250,000.00 1,200 LF Of 16" ,12 & 8" 6830 NE 185th Street Improvements Att. Steve Dennehey Water Main W/ Kenmore WA 98028 (425) 398-4400 Appurtenances City Of Bothell Water Main Replacement City Of Bothell $285,000.00 Installation of 670 LF of 12" & 8" 9654 NE 182nd Street Phase 11- Sammamish Steve Morikowa DI Pipe. & 430 LF of 14" HDPE under Bothell WA River Crossing (425) 486-2768 the Sammamish river by Directional Drill Lake Stevens Sewer District Lundeen/Vernon Road Gray & Osborne $1,346,000.00 Installation of 4,000 LF of 9327 4th Street NE Suite #8 Bypass - Phase 2 Att- Warren Perkins 22" HDPE, 200 LF of 10" Everett WA (206) 284-0860 HDPE Force Main & 2,400 LF Of 24% 8" PVC Gravity Northshore Utility District 187/63 Northshore Utility Dist. $189,000.00 3,500 LF Of 8",6" & 4" 6830 NE 185th Street Water Main Att: Steve Dennehey Water Main W/ Kenmore WA 98028 Replacement (425) 3984400 Appurtenances City Of Poulsbo Front Street NE City Of Poulsbo $1,500,000.00 +/- 4,500 LF of Street 19050 Jensen Way/PO Box 98 Improvements Att Andrzej Kasimak Reconstruction Inc. Water, Poulsbo WA 98370 Project (360) 779-5111 Sewer,Storm Conc.ACP King County Water District # 90 May Valley Road Roth Hill Engineering $526,499.00 7,5W LF Of 12" DI 15606 SE 128th Street Water Main Att: Kevin Goss Water Main W/ Renton WA 98059 Replacement (425) 869-9448 Appurtenances King County Water District # 20 S.120th Street KCWD # 20 $149,200.00 2,000 LF Of 8" DI 126061st Ave South Water Main Att: Ron Malaspino Water Main W/ Seattle WA 98168 Replacement (206) 243-3990 Appurtenances City Of Milton 1999 Water System City Of Milton $230,000.00 4,500 LF Of 8" DI 1000 Laurel Street Improvements Att Glen Baker Water Main W/ Milton WA 98354 Project (253) 922-8738 Appurtenances City Of Sultan Commercial/Industrial City Of Sultan $510,000.00 5,000 LF Of 8"& 6" Public Works Dept. Sewer LID 97-1 Att: Gary Keeley PVC & DI Gravity Sewer 7031st Street Schedule A (360) 793-1262 W/ Street Improvements Sultan WA 98294 Woodinville Water District Siphon # 1 Earth Tech $552,000.00 Install 300 LF of 12"HDPE Casing W/ 17238 Woodinville - Duvall Rd Improvements Att: Craig Chambers 8" HDPE Carrier under the Sammamish Woodinville WA 98072 (425) 455-9494 River By Direct. Drill w/Siphon Structures City Of Monroe Beaton Road City Of Monroe $159,000.00 4,000 LF Of 8" PVC 806 West Mann Street Sewer Force Main Att Jeff Bames Force Main Monroe WA 98272 (360) 794-7400 City Of Oak Harbor 1999 Water System City Of Oak Harbor $498,500.00 8,800 LF Of 12", 8"& 6" 865 Barrington Drive Improvements Att: Quin Clements DI & PVC Water Main Oak harbor WA 98277 Contract 99-1 (360) 679-5551 Highline Water District 1998 Watermain Highline Water District $693,000.00 7,100 LF Of 12", 8"& 6" 23828 30th Ave South Replacements Att Keith Harris DI Water Main Kent WA 98032 Contract 98-1 (206) 824-0375 Northshore Utility District 1996 PWTF Phase 3 Northshore Utility Distr. $1,720,000.00 7,800 LF Of 8"& 6" DI & 6830 NE 185th Street Simonds Road Sewer & Att Jack Stillwell PVC Sewer/5,200 LF Of Kenmore WA 98028 Water Improvements (425) 398-4400 12"& 8" DI Water Main Saratoga Water District c/o 1997 Water Main Pennhallegon Associates $510,000.00 8,800 LF Of 8" & 6" Penhallegon Associates Replacement Consulting Engineers DI Water Main Project Att Larry Brebberman (425) 827-2014 Penn Cove Water District c/o Water System Penhallegon Associates $620,000.00 15,000 LF Of 8",6" Penhallegon Associates Eng. Improvements Consulting Engineers & 4" DI Water Main Schedule A Att Marty Penhallegon (425) 827-2014 City Of Lynnwood Sanitary Sewer Gray & Osborne $410,000.00 24" PVC Gravity 19100 44th Avenue West Replacement On Att: Ken Enns Sewer Main w/ Lynnwood WA 98036 76th Ave West Phase II (206) 284-0860 Extensive Bypassing PUD#10f Snohomish County Lake Stevens PUD #1 Of Snoh. Cnty. $540,000.00 8" & 12" DI 2320 California Street C.I.P. Pipelines Att Brant Wood Water Main Everett WA 98206 Schedules 1 thru 5 (425) 258-8211 Northshore Utility District 130/64 Sewer Northshore Utility Distr. $410,000.00 8" PVC and DI 6830 NE 185th Street Public Works Att: Dick Todd Or Gravity Sewer System Kenmore WA 98028 Project Jack Stillwell (425) 398-4400 City Of Toppenish Wastewater Collection Gray & Osborne Inc. $995,000.00 8" thru 15" PVC 21 West First Avenue System Schedules Yakima WA Gravity Sewer System Toppenish Wa 98948 A,B,C,D,E & F Att: Michael Rohrich (509) 453-4833 City Of Mountlake Project 95-1 City of Mountlake Tenr. $469,000.00 10,000 LF of 8" DI Terrace Water Main Engineering Department Water Main 23204 58th Ave W Replacement Att: Kjell Johnson Mountlake Terrace WA (206) 776-1161 98043 Alderwood Water District Swamp Creek Trunk KCM Inc. $2,370,390.00 30",24",12",& 8" DI, PVC 3626156th Street SW Sewer Phase 3 Att: Doug Genzlinger & Concrete Gravity Lynnwood WA 98037 (206) 443-5354 Sewer System Highline Water District Water Main Penhallogen Associates $725,000.00 12" DI Transmission 23828 30th Ave S Replacement Att: Zenon Zazula and Distribution Main Kent WA 98032 Phase 11 (206) 827-2014 Hillcrest Village Water 1994 Water Main HCW-L Associates $1,250,000.00 300,000 Gal, Reservoir, Company Replacement 4010 Stone Way N Hydropnumatic and Oak Harbor WA Seattle WA 98103 Chlorination Facilities, & Att: Erik Davido Distribution Pipelines (206)632-2664 Alderwood Water Distr. Swamp Creek Trunk KCM Inc. $914,000.00 12",16",& 24" DI, PVC 3626156th Street SW Sewer Phase 1 Att: Doug Genzhnger & Concrete Gravity Lynnwood WA 98037 Schedule 1-B (206) 443-5354 Sewer System Silver Lake Water Distr. 4.2 Million Gallon Silver Lake Water Distr. $900,400.00 4.2 Million Gal. Reservoir 2210132nd Street SE Reservoir And Att Bruce Nelson w/Pump Station(VFD) Everett W A 98204 Pump Station & associated Piping City Of Lynnwood Sanitary Sewer Gray & Osborne $1,060,000.00 24" DI Sewer Force Main 19100 44th Ave West Improvements Att: Tim Osborne Lynnwood WA 98036 (206) 284-0860 City Of Sedro Woolley Treatment Plant City Of Sedro Woolley $453,000.00 16" DI Outfall 720 Murdock Street Outfall Att: Dale Velasquez Gravity Sewer Sedro Woolley Wa 98284 (360) 855-1661 City Of Roslyn Schedule A Sewer Gray & Osborne $1,240,000.00 Sewage Lagoons, 13 South 1st Street Rehabilitation And Att: Tom Zerkel Treatment Facilities & Roslyn WA 98941 Treatment Plant (206) 284-0860 Sewer Collection System Lake Stevens Sewer Distr ULID # 7 Lake Stevens Sewer Distr $533,000.00 12",18",& 24" PVC and 9327 4th Street NE Sanitary Sewer Att: Darwin Smith Concrete Sewer Main Everett WA 98205 (206) 334-8588 Rosehill Water District 1989 Water main Repl. S.T. Engineering $1,259,000.00 6",8",12",& 16" DI 13013 NE 65th Street 1990 Water main Repl. Att Owen Bond $1,751,000.00 Transmission And Kirkland WA 98033 (206) 483-9389 Distribution Pipelines Northshore Utility Distr. ULID # 73 Northshore Utility Distr. $490,000.00 7,000 LF of DI & PVC 6830 NE 185th Street Sanitary Sewer Att Dick Todd Sanitary Sewer Main Kenmore WA 98028 (425) 398-4400 BUNO EXCAVATORS. 1- CAT 345 B 1- CAT 321 CLCR 1- JOHN DEERE 892 1- JOHN DEERE 792 2- CAT 314 1- JOHN DEERE 490 1- HITACHI 135 1- HITACHI EX 135 UR WHEEL LOADERS: 1- CATERPILLAR 938G 1- JOHN DEERE 624G 1- CATERPILLAR 936E 1- JOHN DEERE 544H 1- JOHN DEERE 544E 2- CATERPILLAR IT28 1- CATERPILLAR 908 1- ASV SKID STEER CRAWLER TRACTORS: 1- CATERPILLAR D-5 GRADERS. 1- JOHN DEERE 570 B GRADER CONSTRUCTION, LLC. EQUIPMENT LIST **ALL EQUIPMENT OWNED" 2- CAT 312 EXCAVATOR 1- CAT 315 EXCAVATOR 3- CAT 320 EXCAVATOR 1- CAT 304.5 MINI EXCAVATOR 1- YANMAR 030 MINI EXCAVATOR 1- KUBOTA 091MINI EXCAVATOR 2- KUBOTA 008 MINI EXCAVATOR 1- BOBCAT 430 HAG MINI EXCAVATOR COMPACTION EQUIPMENT: 1- HYSTER VIBRATORY TOW ROLLER 1- INGERSOLL-RAND WALK BEHIND ROLLER 1- ALLIED HOE PAC 9700 1- ALLIED HOE PAC 5800 BACKHOF/LOADERS: 1- CASE 580K 4- CASE 580L TRUCKS: 1- KENWORTH 15 TON BOOM TRUCK 6- MACK DUMP TRUCKS 10-12 CY 4- 10 CY DUMP PUP TRAILERS PIPE BURSTING SYSTEM: 1- TRS HYDRAHAUL 225 PIPELINE REPLACEMENT MACHINE 2- B-175 MAIN PIPELINE REPLACEMENT MACHINE 2- B-100 LATERAL PIPELINE REPLACEMENT MACHINE MISCELLANEOUS: GENERATORS, PUMPS, CONCRETE SAWS, HOLE HOGS, PIPE SAWS, TEST PUMPS, SHORING BOXES, STEEL PLATES, ETC... BUNUC-1 UN IU: GI A,11c"�RL7® CERTIFICATE OF LIABILITY INSURANCE AT03/26D/YYYY) P3/26/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 425-489-4500 CONTACT NAME: Hub International Northwest P. 0. Box 3018 425-489-4501 Bothell, WA 98041-3018 Jenny Landers /C No): A/C NNo Ext : VC. E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Indemnity Co. 25658 INSURED Buno Construction LLC 20219 99th Ave SE Snohomish, WA 98290 INSURER B : The Charter Oak Fire Ins Co Travelers Prop Cas Co. of Amer INSURER C : 25674 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 ADDL U POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR DTC0527D29651ND13 06/06/13 06/06/14 E TO RENT PREMISES Ea occurrence $ 300+000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X JECPRO LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO BA527D2965CNS13 06/06/13 06/06/14 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X I NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 C EXCESS LIAB CLAIMS -MADE DTSMCUP527D2965TIL13 06/06/13 06/06/14 DED X I RETENTION$ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A DTC0527D2965IND13 A SHINGTON STOP GAP 06/06/13 06/06/14 WC STATU- OTH- TORY LIMITS I X ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT: CITY OF RENTON, AND ITS OFFICERS, OFFICIALS, AGENTS, EMPLOYEES, AND VOLUNTEERS. COVERAGE IS PRIMARY AND NON—CONTRIBUTORY. PER PROJECT AGGREGATE AND WAIVER OF SUBROGATION APPLY. SEE ATTACHED ENDORSEMENTS. RE: MONTEREY TERRACE WATER MAIN REPLACEMENT, CAG-14-018. CERTIFICATE HOLDER CANCELLATION CITYOFR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF RENTON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 MILL AVENUE S. RENTON, WA 98055 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) 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 not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows; a) 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. b) 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: 1. 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 coverage or the end of the policy period, whichever is earlier. 3. 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 to the 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 or 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 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. How, when and where the "occurrence" or offense took place; IL 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: I. 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 otherwise comply with all policy conditions. 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 insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. 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; b. While that part of the contract or 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 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot B. Damage To Premises Rented To You C. Increased Supplementary Payments D. Incidental Medical Malpractice E. Who Is An Insured — Newly Acquired Or Formed Organizations F. Who Is An Insured — Broadened Named Insured — Unnamed Subsidiaries G. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. B. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion j., Damage To Property, in Para- graph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. 2. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A. BODILY H. Blanket Additional Insured — Lessors Of Leased Equipment I. Blanket Additional Insured — States Or Political Subdivisions — Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogation M. Amended Bodily Injury Definition N. Contractual Liability — Railroads INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water; unless Exclusion f. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion — All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in its title. A separate limit of insurance applies to "premises damage" as described in Para- graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 0 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage" to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Declarations of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract' in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for "premises damage" is not an "insured contract'; 5. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage"; or 7. Paragraph 4.b.(1)(c) of SECTION IV — COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGE: b. Up to $2,500 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person. 2. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- ing to provide: (i) "Incidental medical services" by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (ii) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan ser- vices" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 © 2011 The Travelers Indemnity company. All rights reserved. CG D3 16 11 11 3. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one per- son will be deemed to be one 'occurrence". 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 6. The following is added to Paragraph 4.b., Ex- F cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a.(1) of Section 11 — Who Is An Insured. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II — WHO IS AN INSURED: COMMERCIAL GENERAL LIABILITY 4. Any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, of which you are the sole owner or in which you maintain the ma- jority ownership interest, will qualify as a Named Insured if there is no other insurance which provides similar coverage to that or- ganization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it, and we agree in writing that it will con- tinue to be a Named Insured until the end of the policy period; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offense committed before you acquired or formed the organization. WHO IS AN INSURED — BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION 11 — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declara- tions is a Named Insured if you maintain an own- ership interest of more than 50% in such subsidi- ary on the first day of the policy period. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such sub- sidiary. CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or "personal injury" or "adver- tising injury" caused by an offense that is committed, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary to, or non- contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other insur- ance. H. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", "property dam- age", "personal injury" or "advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- ted, subsequent to the execution of that con- tract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" that occurs, or "personal injury" or "advertising injury" caused by an of- fense that is committed, after the equipment lease expires. C. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary to, or non-contributory with, such other insurance, in which case this insurance will be primary to, and non-contributory with, such other in- surance. I. BLANKET ADDITIONAL INSURED — STATES OR POLITICAL SUBDIVISIONS — PERMITS The following is added to SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an Insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; or b. Any "bodily injury" or "property damage" in- cluded in the "products -completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: COMMERCIAL GENERAL LIABILITY (iii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not preju- dice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 0 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily injury" or "property damage" that oc- curs; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. Page 6 Of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11 POLICY NUMBER: DT-CO-527D2965-IND-13 COMMERCIAL GENERAL LIABILITY ISSUE DATE:06-07-13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, GENERAL AGGREGATE IN A WRITTEN CONTRACT WHICH IS IN EFFECT LIMIT SHOWN ON THE DURING THIS POLICY PERIOD, TO PROVIDE A DECLARATIONS. SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project' shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject', and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project'. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project' shown in the Schedule above: .-^ r%1% 44 AA O%A TI..- T........I...- nr%nA r)--- 4 ..Ir n COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from 'occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project' shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project'. F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. n-.... n . n r,__...:_"4 TL... T.......1...... I.,.d..-...- 4: !'+........ .. ..... 11AAA ^^ r%1% AA AA AA PUBLIC WORKS DEPARTMENT City of PRECONSTRUCTION CONFERENCE sign -in Sheet DATE: April 24, 2014 TIME: 2:30 p.m. —4:00 p.m. PLACE: City Hall Conference Room #511 Project Name: Monterey Terrace Water Main Replacement Project (CAG-14-014) Project Manager Andrew Weygandt Phone (425) 430-7208 Fax (425) 430-7241 E-mail: awey%zandt(&rentonwa.gov Contractor Name/Address: Buno Construction, LLC 20219 991h Ave SE Sonhomish, WA 98296 Phone 360-863-2893 Contact Name Dan Buno Phone 206-423-4512 Fax 360-863-3981 E-mail: Construction Location NE 3` & Monterey Terrace NE Printed Name Signature j o &1 M G , k rV t5 30 731 9, Q a e4— 2S3_1* e _75 38 ( - Z;&t�i i A !1 & 21r0-24$2 kiln . ' . 0:)Ol O6 3,1�11, 11� d�Sil `J`oal Printed Name Signature