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HomeMy WebLinkAboutWWP273712 (6)i NSULIANTS LETTER OF TRANSMITTAL DATE: January 4, 2017 City of Renton TO: Renton City Hall — 51h Floor 1055 South Grady Way Renton, WA 98057-3232 ATTN: John Hobson THE FOLLOWING ITEMS ARE: ❑ PROJECT NO. 14-10291.03 Central Renton Sewer RE: Interceptor Reline & Upsize Project REQUESTED ENCLOSED SENT VIA US MAIL NO. OF COPIES DESCRIPTION 1 22"x34" Record Drawings on Mylar 1 CD containing electronic Record Drawing files (AutoCAD and PDF) General Remarks: John, Please find enclosed one set of record drawings and one CD with electronic files of the record drawings. Thank you again for the opportunity to work with the City. Sincerely, BHC Consultan , LLC -- Tyl6rWhitehouse, P.E. Project Manager cc 1601 Fifth Avenue, Suite 500 • Seattle, WA 98101 • (206) 505-3400 • FAX (206) 505-3406 www. bhcco nsu Itants.corn wm*&N&n state 111118POd Request for Approval of Material Contract Number 'AG-15-11 K(City of Renton No. WW9-27-03712) FA Number SR Date 9'13/2016 Section / Title of Project County Central Renton Sewer Interceptor Reline & Upsize Ki ILJ Contractor Road C'onstnlction Northwest, Inc. Subcontractor ICON Materials This form shall be completed prior to submittal. If this form is not complete at time of submittal it may be returned for information that was omitted. For assistance in completing, see Instructions and Example For WSDOT Use Only RAM # 017-1 Bid Item No. Material or Product'Type Name and Location of Fabricator. Manufactureror Pit Number Specification Reference PE/QPL Code Hdqtr QPL Code 21 1/2' HMA for Pavement Repair Class 1/2" PG 70-22 ICON Materials Auburn WA 9-03.8 �- C. Project in er Date 9 / ZL'/(c State Materials Engineer Date Acceptance Action Codes f r use by Project Engineer and State Materials Laboratory 1. Acceptance Criteria: Acceptance based upon 'Satisfactory' Test Report for samples of materials to be incorporated into project. 2. Acceptance Criteria: Mfg. Cert. of Compliance for 'Acceptance' prior to use of material. 3. Acceptance Criteria: Catalog Cuts for 'Acceptance' prior to use of material. catalog Cur Approval ❑ l <, ❑ N„ 4. Acceptance Criteria: Submit Shop Drawings for'Approval' prior to fabrication of material. 5. Acceptance Criteria: Only 'Approved for Shipment'. 'WSDOT Inspected' or 'Fabrication Approved Decal' material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. & Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution ❑ Contractor ❑ Region Operations Engineer ❑ Fabrication Inspection DOT Form 350-071 EF Revised 12/2012 ❑ Region Materials ❑ State Materials Lab M/S 47365 State Materials Engineer Distribution ❑ General File ❑ Signing Inspection ❑ Other vamhkwm a DePortaHm r'd �P Request for Approval of Material Contract Number 7FA 'AG-15-11MC�ity ofRenton No. %VXV9-27-03712 Number SR Date 9 9 2016 Section / Title of Project Central Renton Sewer Interceptor Reline & Upsize County King Contractor Road Construction Northwest, Inc. Subcontractor This form shall be completed prior to submittal. If this form is not complete at time of submittal it may be returned for information that was omitted. For assistance in completing, see Instructions and Example For WSDOT Use Only RAM # 017-1 Bid Item No Material or ProductType Name and Location of Fabricator, Manufacturer or Pit Number Specification Reference PE'QPL Code Hdgtr.,'QPL Code Sanded Manhole Collar GPK Products Inc. Faro ND t Project �— Date `f Z / State Materials Engineer Date Acceptance Action Codes for use by Project Engineer and State Materials Laboratory 1. Acceptance Criteria: Acceptance based upon 'Satisfactory' Test Report for samples of materials to be incorporated into project. 2. Acceptance Criteria: Mfg. Cent. of Compliance for 'Acceptance' prior to use of material. 3. Acceptance Criteria: Catalog Cuts for 'Acceptance' prior to use of material. C'atalog Cut Approved ❑ Ye, ❑ Na 4. Acceptance Criteria: Submit Shop Drawings for'Approval' prior to fabrication of material. 5. Acceptance Criteria: Only'Approved for Shipment','WSDOT Inspected' or'Fabrication Approved Decal' material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. 8. Source Approved: 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld: 11. Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution ❑ Contractor ❑ Region Operations Engineer ❑ Fabrication Inspection DOT Form 350-071 EF Revised 1212012 ❑ Region Materials ❑ State Materials Lab M/S 47365 State Materials Engineer Distribution ❑ General File ❑ Signing Inspection ❑ Other Road Construction Northwest, Inc. REQUEST FOR INFORMATION No. 00001 Po Box 188 Renton, WA 98057 TITLE: Manhole Lid DATE: 9/9/2016 PROJECT: Central Renton Sewer Interceptor R&U TO: Attn: John Hobson City of Renton 1055 South Grady Way Renton, WA 98057 JOB: 1509 STARTED: COMPLETED: REQUIRED: 9/16/2016 REQUEST: What is the City of Renton's recommended lock down method for the new manhole casting lid? Requested By:Road Construction Northwest, Inc. Date: 9/9, 2016 Signed: (/ 9B4t4g, Jake Boose Expedition M ANSWER: �STcQ- Q �� 1 1i �2c�71 b c a- �r v �c� 'r-4� N1 (-1 c c,? p—t+G 1+� i �l-� 2 5 i a..�ll.E�S �Sp�-L�2 ►-AL T-s --)Z �Tu� Answer Signed: Date: 9/9/2016 DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT OF Kenton' CIP Permit: U16004749 IVR Number: 16004749 Permit Name: Central Renton Sewer Interceptor Reline & Upsize Address/Location: 353 SUNSET BLVD N Parcel Number: 1723059095 Application Date: 08/23/2016 Permit Type: Engineering Issue Date: 08/23/2016 Permit Work Class: CIP Expiration Date: 08/23/2017 Description: Central Renton Sewer Interceptor Reline & Upsize Billing Type Name Address Phone X Applicant John Hobson 1055 S Grady Way B: (425) 430-7279 City of Renton - Wastewater Utility Renton, WA 98057-3232 Contact Jeff Kanyer PO Box 188 B: (425) 254-9999 Road Construction Northwest Renton, WA 98057-0188 Owner KERB MARY JO 22225 SE 4TH ST SAMMAMISH WA 98073 • Permission is hereby given for the work described on this permit according to the conditions hereon and according to the approved plans and specifications pertaining thereto, subject to compliance with the Ordinance of the City of Renton . • This permit and plans must be posted at the job site at all times. • 1 hereby certify that no work is to be done except as described above and in approved plans, and that work is to conform to Renton codes and ordinances. • Call (425) 430-7203 or go to: www.MyBuildingPermit.com one working day in advance to schedule an inspections and for ANY work in the Right of Way. • Call 8 1 1 to locate underground utilities at least two full business days prior to any excavation . • In accordance with RCW 19.122.033(4) the permit holder is required to contact (Williams Northwest Pipeline at 425.868.1010) (Olympic Pipeline at 206.510.0575)(Puget Sound Energy at 425.457.5816) to request a consultation with the transmission pipeline company prior to performing any construction or excavation activities . This requirement to consult with the transmission pipeline company is in addition to the requirement to Call before You Dig as required in RCW 19.122. (Signature) (Date) THIS PERMIT AND PLANS MUST BE POSTED AT THE JOB SITE AT ALL TIMES Page 1 of 1 Client#: 105477 MCCACONS2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/09/2015 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 Propel Insurance Seattle Commercial Insurance 925 4th Ave, Suite 3200 Seattle, WA 98104 CONTACT NAME: Monica Parks PHONE 800 499-0933 FAX 866.577.1326 A/C, No, Ext : A/C, No E-MAIL Monica.Parks@propelinsurance.com ADDRESS: p INSURER(S) AFFORDING COVERAGE NAIC ii INSURER A: Charter Oak Fire Insurance Comp 25615 INSURED INSURER B : Travelers Property Casualty Coo 25674 Road Construction Northwest Inc dba RCNW INSURER C : Travelers Indemnity Co of Conne 25682 Road Construction Southwest Inc dba RCSW PO BOX 481 Renton, WA 98057 Homeland Insurance Company of N INSURER D : m P Y 34452 INSURER E : Travelers Property Casualty Ins 36161 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 CONTRACTOR 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 INSR WVD I POLICY NUMBER /YSUBR POLICY EFF MWDDYYY POLICY EXP LIMITS MM/DD/YYYY A GENERAL LIABILITY X X DTCOBB33735000F 5/15/2015 05/15/2010 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $30O 000 X COMMERCIAL GENERAL LIABILITY (15) CLAIMS -MADE a OCCUR MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY S1,000,000 X PD Ded:$5,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s 2,000,000 S 17 POLICY XI PRO- JECT LOC C AUTOMOBILE LIABILITY X X DT8108B337350TCT 5/15/2015 05/15/2016 ND EOaccicdentSINGLELIMIT S1,000,000 BODILY INJURY (Per person) S X ANY AUTO (15) BODILY INJURY (Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X AUUTOSNON-OWNED ER Perm cidentDAMAGE S S B X UMBRELLA LIAB X OCCUR X X DTSMCUP8B337350T 5/15/2015 05/15/201 EACH OCCURRENCE S6 000 000 AGGREGATE S6 OOO 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION S$1O 000 S C' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YI N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N I A DTJU68B33735015 Stop Gap Included 5/15I2015 OS/15I2016, TW STATU- OTH- E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT S1 ,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below D Pollution 7930033390000 5/15/2015 05/151201d Limit: $2,000,000 Liability Deductible: $5,000 E I Install. Floater QT6602F241857TIL 5/15115 05/15/15 Limit: $25K Ded: $1K DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Central Renton Sewer Interceptor Reline & Upsize. The City of Renton and BNSF Railway Company are additional insured per the attached endosrement. IIPTCI City of Renton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1055 South Grady Way ACCORDANCE WITH THE POLICY PROVISIONS. Renton, WA 98057 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S 1793418/M 1790193 KTR00 Road Construction Northwest Inc dba RCNW DTC08B33735000F 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: L 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 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 Road Construction Northwest Inc dba RCNW DT1C08B337350C0F COMMERCIAL GENERAL LIABILITY i. How, when and where the '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 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 C 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 M Road Construction Northwest Inc dba RCNW DTC08b33735000F 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 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 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 1— 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 1111 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Road Construction Northwest Inc dba RCNW DTC08B33735000F 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 Road Construction Northwest Inc dba RCNW DTC08B33735000F COMMERCIAL GENERAL LIABILITY 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 — COW 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- 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 ll — Who Is An Insured. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION it —WHO IS AN INSURED: 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. F. WHO IS AN INSURED — BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURER: 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. CIS D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 Road Construction Northwest Inc dba RCNW DTC081333735000F 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. 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. Iscaused, 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. BLANKET ADDITIONAL INSURED — STATES OR POLITICAL SUBDIVISIONS — PERMITS The following is added to SECTION If — 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 Road Construction Northwest Inc dba RCNW DTC081333735000F COMMERCIAL GENERAL LIABILITY 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: (ii) 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 1111 O 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Road Construction Northwest Inc dba RCNW DTC08633735000F 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: G. 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 Road Construction Northwest Inc dba RCNW 05/ 15/2015 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): ANY DESIGNATED PROJECT(S) YOU ARE REQUIRED TO INCLUDE A DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT COVERAGE ON THIS POLICY 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. 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: CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 usas�e Road Construction Northwest Inc dba RCNW 05/15/2015 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 I) 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 fit — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 Road Construction Northwest Inc dba RCNW DT8108B337350TCT COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. 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 the 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. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COVERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE —GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABILITY COV- ERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who is An Insured, of SECTION II — LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section 11. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. CA T3 53 0212 O 2010 The Travelers Indemnity Company Page 1 of 4 Includes copyrighted material of Insurance Services Office. Inc. with its permission. Road Construction Northwest Inc dba RCNW DT8108B337350TCT COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.S., within such country or jurisdiction, for Liability Other Insurance, of SECTION IV — BUSI- Coverage for any covered "auto" that you NESS AUTO CONDITIONS: lease, hire, rent or borrow without a driver for b. For Hired Auto Physical Damage Cover- a period of 30 days or less and that is not an age, the following are deemed to be cov- "auto" you lease, hire, rent or borrow from "employees", ered "autos" you own: any of your partners (if you are a partnership), members (if you are a limited (1) Any covered "auto" you lease, hire, liability company) or members of their house - rent or borrow; and holds. (2) Any covered "auto" hired or rented by (a) With respect to any claim made or "suit" your "employee" under a contract in brought outside the United States of that individual "employee's" name, America, the territories and possessions with your permission, while perform- of the United States of America, Puerto ing duties related to the conduct of Rico and Canada: your business. (i) You must arrange to defend the "in - However, any "auto" that is leased, hired, sured" against, and investigate or set - rented or borrowed with a driver is not a tle any such claim or "suit" and keep covered "auto". us advised of all proceedings and ac- D. EMPLOYEES AS INSURED tions. The following is added to Paragraph A.1., Who Is (ii) Neither you nor any other involved An Insured, of SECTION II — LIABILITY COV- "insured" will make any settlement ERAGE: without our consent. Any "employee" of yours is an "insured" while us- (III) We may, at our discretion, participate ing a covered "auto" you don't own, hire or borrow in defending the "insured" against, or in business or your personal affairs. in the settlement of, any claim or your E. SUPPLEMENTARY PAYMENTS — INCREASED "suit". LIMITS (iv) We will reimburse the "insured" for sums that the "insured" legally must 1. The following replaces Paragraph A.2.a.(2), pay as damages because of "bodily of SECTION II — LIABILITY COVERAGE: injury" or "property damage" to which (2) Up to $3,000 for cost of bail bonds (in- this insurance applies, that the "in- cluding bonds for related traffic law viola- sured" pays with our consent, but tions) required because of an "accident" only up to the limit described in Para - we cover. We do not have to furnish graph C., Limit Of Insurance, of SEC - these bonds. TION Il — LIABILITY COVERAGE. 2. The following replaces Paragraph A.2.a.(4), (v) We will reimburse the "insured" for of SECTION 11— LIABILITY COVERAGE: the reasonable expenses incurred (4) All reasonable expenses incurred by the with our consent for your investiga- "insured" at our request, including actual tion of such claims and your defense loss of earnings up to $500 a day be- of the "insured" against any such cause of time off from work. "suit", but only up to and included within the limit described in Para- F. HIRED AUTO — LIMITED WORLDWIDE COW graph C., Limit Of Insurance, of ERAGE —INDEMNITY BASIS SECTION II — LIABILITY COVER - The following replaces Subparagraph (5) in Para- AGE, and not in addition to such limit. graph B.7., Policy Period, Coverage Territory, Our duty to make such payments of SECTION IV — BUSINESS AUTO CONDI- ends when we have used up the ap- TIONS: plicable limit of insurance in pay- (5) Anywhere in the world, except any country or ments for damages, settlements or jurisdiction while any trade sanction, em- defense expenses. bargo, or similar regulation imposed by the (b) This insurance is excess over any valid United States of America applies to and pro- and collectible other insurance available hibits the transaction of business with or Page 2 of 4 © 2010 The Travelers Indemnity Company CA T3 53 02 12 Includes copyrighted material of Insurance Services Office. Inc. with its permission. Road Construction Northwest Inc dba RCNW DT5108B337350TCT COMMERCIAL AUTO to the "insured" whether primary, excess contingent or on any other basis. (c) This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE —GLASS The following is added to Paragraph D., De- ductible, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.1b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL EFFECTS The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Effects We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Effects coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); The following replaces the first sentence in Para- (c) A member (if you are a limited liability com- graph A.4.a., Transportation Expenses, of pany); SECTION III — PHYSICAL DAMAGE COVERA- (d) An executive officer, director or insurance GE: manager (if you are a corporation or other or - We will pay up to $50 per day to a maximum of ganization); or $1,500 for temporary transportation expense in- (e) Any "employee" authorized by you to give no- curred by you because of the total theft of a cov- tice of the "accident" or "loss". ered "auto" of the private passenger type. CA T3 53 02 12 © 2010 The Travelers Indemnity Company Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Road Construction Northwest Inc dba RCNW DT8108B337350TCT COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non -renewal. Page 4 of 4 © 2010 The Travelers Indemnity Company CA T3 53 02 12 Includes copyrighted material of Insurance Services office. Inc. with its permission. UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE The following is added to Paragraph 11., OUR RIGHT TO RECOVER FROM OTHERS., of SECTION IV — CONDITIONS.: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" caused by an "occurrence" that takes place; or b. "Personal injury" or "advertising injury" caused by an "offense" that is committed; subsequent to the execution of the contract or agree- ment. UM 04 88 07 08 O 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. This page has been left blank intentionally. Road Construction Northwest, Inc. TRANSMITTAL No. 00001 PO Box 188 Renton, WA 98057 PROJECT: Central Renton Sewer Interceptor R&U TO: City of Renton 1055 South Grady Way Renton, WA 98057 ATTN: John Hobson DATE: 7/10/2015 REF: Signed Contract Document WE ARESENDING: ED FOR: ACTION TAKEN: ❑ Shop Drawings Rr Approval ❑ Approved as Submitted ❑ Letter 1r Your Use ❑ Approved as Noted ❑ Prints 19 As Requested ❑ Retumed After Loan ❑ Change Order ❑ Review and Comment ❑ Resubmit ❑ Plans ❑ Submit ❑ Samples SENT VIA: ❑ Retumed ❑ Specifications Eff Attached ❑ Returned for Corrections ❑ Other: liff Separate Cover Via: HAND DELIVERED ❑ Due Date: ITEM NO. COPIES DATE ITEM NUMBER REV. NO. DESCRIPTION 1 2 7/10/2015 CON CAG-15-118 Signed Contracts 2 2 7/10/2015 COI Performance/Payment Bonds 3 1 7/10/2015 COI Signed Fair Practices Affidavit of Compliance 4 1 7/10/2015 COI Certificate of Insurance 5 1 7/10/2015 COI Signature Authorization 6 1 7/10/2015 COI Copy of Current WA St Contractor's License 7 1 7/10/2015 COI Copy of Current City of Renton Business License Remarks: CC: Acctg/Job Files Signed: Arlene Schuchard STATUS E,pedaion $ Denis/oLaw City Of Ma f r ~ Y O� ` � • Public Works Department - Gregg Zimmerman, P. E., Administrator June 23, 2015 Mr. Peter J. Kenney Road Construction Northwest, Inc. P.O. Box 188 Renton, WA 98057-0188 RE: Contract Documents — Central Renton Sewer Interceptor Reline & Upsize Dear Mr. Kenney: At the Renton City Council meeting on June 22, 2015, the Council accepted Road Construction Northwest, Inc.'s bid of $393,970.05, for the Central Renton Sewer Interceptor Reline & Upsized project. For execution of the contract, please submit the following information as soon as possible so we can prepare the contract documents for review and signature by the Mayor: 1. A list of names, addresses, phone numbers, and emergency phone numbers for: Responsible Officer, lob Foreman, and Bonding Agent. Corporation letter or resolution giving names of those authorized to sign the contract and samples of their signatures. Photocopy of your current Washington State Contractor's License (not master license). 4. Photocopy of your current City of Renton Business License. S. Two signed contract bonds on City of Renton forms (enclosed). 6. One signed City of Renton Fair Practices Affidavit of Compliance (enclosed). 7. Two signed contracts UNDATED (enclosed). The date will be filled in when signed by the Mayor. 8. One Certificate of Insurance for 2015 in accordance with Section 1-07.18 of the Special Provisions. Please add the City of Renton and BNSF Railway Company (per section 13.6.9 of BNSF Temporary Occupancy Permit) as additional insureds. Renton City Hall • 1055 South Grady Way • Renton, Washington 98057 • rentonwa.gov Mr. Kenney Page 2 of 2 June 23, 2015 9. The insurance policy declaration pages of all required insurance policies obtained from the insurance carrier. After the contract information is submitted, we will need the following information to review and approve before construction can start. We would like to have most of it before we schedule a pre -construction conference. If you intend to use private property for material storage or staging you will need the approval of our Development Services Division. In some instances this may include the need for a Temporary Use Permit. This does not apply to storage and staging areas within City rights -of -way. 1. Provide material submittals as required for the work involved with this job. This will include, but not be limited to, information on the proposed source and specifications of all materials that will be used in the project (e.g.; Pipe, Manholes, Couplings, Castings, Aggregates, etc.) showing that the proposed material meets the project specifications, per Standard Specifications and Special Provisions Section 1- 06.1. Provide any shop drawings and submittals needed for the project per Standard Specifications and Special Provisions Section 1-06. 2. Work Plan showing proposed construction sequencing and schedule for the project. 3. Traffic Control Plan. The form is included with this letter. If you have questions on traffic control requirements, please give me a call. The plan can be reviewed and final adjustments made at the pre -construction conference. 4. Provide a copy of each employee's BNSF Safety Orientation card that certifies completion of the Safety Orientation training, which is required for all employees that will enter the construction site. The Safety Orientation program is required by section 14.2 of the BNSF Temporary Occupancy Permit. Please let me know when you would like to have the pre -construction conference. We will need to notify the private utilities and City Inspector, so there should be a lead-time of at least one week before the conference. Please contact me at 425-430-7279 or jhobson@rentonwa.gov, if you have any questions. SiPnHobs Joon Wastewater Utility Enclosures H:\file Sys\WWP - Waste Water\WWP-27-3712 Central Renton Sewer Interceptor Reline & Upsize\Award Info\Award Letter -Road Construction NW - Central Renton Int Reline & Upsize.doc\ 1DHtp Washington State �% Department of Transportation Request for Approval of Material Contract Number FA Number SR Date CAG-15-118 (City of Renton No. WW9-27-03712) 06/25/15 Section / Title of Project County Central Renton Sewer Interceptor Reline & Upsize KING Contractor Subcontractor Road Construction Northwest. Inc This form shall be completed prior to submittal. If this form is not complete at time of submittal it may be returned for information that was omitted. For WSDOT Use Only For assistance in completing, see Instructions and Example RAM # Bid Material or Name and Location of Fabricator. Specification PE/QPL Hdgtr./QPL Item No. Product/Type Manufacturer or Pit Number Reference Code Code 8 84-Inch Diam. Sewer Manhole Shope Puyallup. WA 7-05 SS 1-09.14(2) 8 Concrete Liner & Coating. Connections. Couplings & etc... Predl Systems Burnaby. BC 7-05.3(5&6) Project Engineer Date State Materials Engineer Date Acceptance Action Codes for use Ky Project Engineer and State Materials Laboratory 1. Acceptance Criteria: Acceptance based upon 'Satisfactory' Test Report for samples of materials to be incorporated into project. 2. Acceptance Criteria: Mfg. Cert. of Compliance for 'Acceptance' prior to use of material. 3. Acceptance Criteria: Catalog Cuts for'Acceptance' prior to use of material. c ataLos Ctit Approved ❑ Ye, []No 4. Acceptance Criteria: Submit Shop Drawings for'Approval' prior to fabrication of material. 5. Acceptance Criteria: Only'Approved for Shipment'.1NSDOT Inspected' or'Fabrication Approved Decal' material shall be used. 6. Acceptance Criteria: Submit Certificate of Materials Origin to Project Engineer Office. 7. Acceptance Criteria: Request Transmitted to State Materials Laboratory for Approval Action. 8. Source Approved. 9. Approval Withheld: Submit samples for preliminary evaluation. 10. Approval Withheld 11. Miscellaneous Acceptance Criteria. Remarks: Project Engineer Distribution ❑ Contractor ❑ Region Operations Engineer ❑ Fabrication Inspection DOT Form 350-071 EF Revised 12/2012 ❑ Region Materials ❑ State Materials Lab M/S 47365 State Materials Engineer Distribution ❑ General File ❑ Signing Inspection ❑ Other Central Renton Sewer Interceptor Reline & Upsize Approval of Material: Bid Item 8 — 84-inch Diam. Sewer Manhole 1. 84" Manhole shall be WSDOT B-15.60-01 as submitted on Shope Concrete Products cut sheet. The Shope cover letter specifies the incorrect WSDOT spec (8-15.40-00). 2. Predl Systems Drawing No. 20.1 does not appear to be applicable to this project. Contractor shall note that a polypropylene wall liner is not required for this manhole. As an option, Contractor may provide Predl Systems polypropylene wall liner in lieu of Wasser MC-Aroshield coating for all interior concrete surfaces above the FRP base liner, provided there is no additional cost to the Owner. 3. Predl Systems Drawing No. 89 includes a polypropylene wall liner above the FRP base liner. As previously indicated, a polypropylene wall liner is not required for this manhole. As an option, Contractor may provide Predl Systems polypropylene wall liner in lieu of Wasser MC-Aroshield coating for all interior concrete surfaces above the FRP base liner, provided there is no additional cost to the Owner. 4. Contractor to verify skewed angles and invert elevations prior to fabrication of base liner as noted on Detail 1, Drawing C-2. Submit revised shop drawing (Predl Systems Dwg No. 89) indicating field verified angles and invert elevations. Adjust manhole dimensions as appropriate. CITY OF RENTON BID TABULATION SHEET 1of1 Project: Central Renton Sewer Interceptor Reline Upsize CAG-15-118 Date: 06/09/15 FORMS Bid Total from Prop & DOL Cert Bid Schedule Bidder Schedule of Prices trppl form Of Reg. Bond of prices *Includes Sales Tax R.L. Alia Company 107 Williams Av South 1 Renton WA "zo 98057 Road Construction Northwest, Inc. P.O. Box 188 2 Renton 93 70. bs' WA 98057 Shoreline Construction, Co. P.O. Box 358 3 Woodinville ✓, G'� WA 98072 Titan Earthwork, LLC. 13806 16th Street East 4 Sumner WA 98390 Engineer's Estimate $347,560.88 Project : Central Renton Sewer Interceptor Reline & Upsize Titan Earthworks R.L. Alia Average Bid BID DATE: June 09, 2015 Item Unit Est. Unit Bid Unit Bid Unit Bid No. Description Quantitv Price Amount Price Amount Price Amount 1 Mobilization and Demobilization Lump Sum 1 107,000.00 107,000.00 30,000.00 30,000.00 53,675.00 53,675.00 2 Traffic Control Lump Sum 1 21,500.00 21,500.00 50,000.00 50,000.00 32,000.00 32,000.00 3 Trench Excavation Safety Systems Lump Sum 1 7,200.00 7,200.00 20,000.00 20,000.00 14,925.00 14,925.00 4 Temporary Erosion/Sedimentation Controls Lump Sum 1 2,000.00 2,000.00 1,000.00 1,000.00 2,000.00 2,000.00 5 Construction Surveying, Staking and As-Builts Lump Sum 1 1,600.00 1,600.00 4,000.00 4,000.00 2,925.00 2,925.00 6 Temporary Dewatering (Wellpoint System) Lump Sum 1 3,500.00 3,500.00 3,000.00 3,000.00 4,650.00 4,650.00 7 Furnish and Install 24-inch PVC Sewer Pipe Linear Foot 125 425.00 53,125.00 250.00 31,250.00 343.75 42,968.75 8 Furnish and Install 84-inch Diameter Sewer Manhole Each 1 45,000.00 45,000.00 88,000.00 88,000.00 63,750.00 63,750.00 9 Connect New Sewer to Existing Manhole Each 1 24,000.00 24,000.00 6,000.00 6,000.00 11,125.00 11,125.00 10 Pre -Installation Cleaning and Inspection Linear Foot 660 13.00 8,580.00 13.00 8,580.00 13.25 8,745.00 11 Excessive Leak Repair for Cured -in -Place Pipe Each 1 3,100.00 3,100.00 3,400.00 3,400.00 3,375.00 3,375.00 12 Furnish and Install 24-inch Diameter Cured -in -Place Pipe Linear Foot 660 107.00 70,620.00 112.00 73,920.00 114.75 75,735.00 13 Reinstate CIPP Laterals Each 3 375.00 1,125.00 400.00 1,200.00 431.25 1,293.75 14 Post CIPP Installation Inspection Linear Foot 660 1.00 660.00 2.00 1,320.00 1.75 1,155.00 15 Remove and Reinstall SMH 2O19 Lump Sum 1 2,200.00 2,200.00 5,000.00 5,000.00 4,550.00 4,550.00 16 Select Imported Trench Backfill Ton 200 40.00 8,000.00 20.00 4,000.00 26.25 5,250.00 17 Crushed Surfacing Top Course Ton 25 42.00 1,050.00 45.00 1,125.00 65.50 1,637.50 18 Controlled Density Fill Cubic Yard 10 132.00 1,320.00 500.00 5,000.00 215.50 2,155.00 19 Construction Geotextile for Soil Stabilization Square Yard 50 12.00 600.00 25.00 1,250.00 12.25 612.50 20 Removal and Replacement of Unsuitable Foundation Material Ton 10 68.00 680.00 50 500.00 42.25 422.50 21 HMA for Pavement Repair Class 1/2" PG 64-22 Ton 25 500.00 12,500.00 450 11,250.00 512.50 12,812.50 22 Cement Concrete Panel Restoration Cubic Yard 15 800.00 12,000.00 500 7,500.00 687.50 10,312.50 23 Cement Concrete Sidewalk Restoration Square Yard 10 300.00 3,000.00 100.00 1,000.00 133.75 1,337.50 24 Cement Concrete Curb and Gutter Restoration Linear Foot 15 150.00 2,250.00 50.00 750.00 68.75 1,031.25 25 Temporary Sewer Bypass Pumping/Systems Lump Sum 1 25,000.00 25,000.00 50,000.00 50,000.00 22,000.00 22,000.00 26 Site Demolition and Restoration Lump Sum 1 1 9,500.00 9,500.00 30,000.00 30,000.00 16,875.00 16,875.00 427,110.00 439,045.00 $397,318.75 40,575.45 41,709.28 $37,745.28 467,685.45 480,754.28 435,064.03 Unit Price was written as $1.07 per linear foot on submitted bid which is excessively unbalanced per Standard Specification 1-02.13 Subsection 2.b. 4 F. Project : Central Renton Sewer Interceptor Reline & Upsize BID DATE: June 09, 2015 Item No. Description Unit Est. Quantit, 1 Mobilization and Demobilization Lump Sum 1 2 Traffic Control Lump Sum 1 3 Trench Excavation Safety Systems Lump Sum 1 4 Temporary Erosion/Sedimentation Controls Lump Sum 1 5 Construction Surveying, Staking and As-Builts Lump Sum 1 6 Temporary Dewatering (Wellpoint System) Lump Sum 1 7 Furnish and Install 24-inch PVC Sewer Pipe Linear Foot 125 8 Furnish and Install 84-inch Diameter Sewer Manhole Each 1 9 Connect New Sewer to Existing Manhole Each 1 10 Pre -Installation Cleaning and Inspection Linear Foot 660 11 Excessive Leak Repair for Cured -in -Place Pipe Each 1 12 Furnish and Install 24-inch Diameter Cured -in -Place Pipe Linear Foot 660 13 Reinstate CIPP Laterals Each 3 14 Post CIPP Installation Inspection Linear Foot 660 15 Remove and Reinstall SMH 2O19 Lump Sum 1 16 Select Imported Trench Backfill Ton 200 17 Crushed Surfacing Top Course Ton 25 18 Controlled Density Fill Cubic Yard 10 19 Construction Geotextile for Soil Stabilization Square Yard 50 20 Removal and Replacement of Unsuitable Foundation Material Ton 10 21 HMA for Pavement Repair Class 112" PG 64-22 Ton 25 22 Cement Concrete Panel Restoration Cubic Yard 15 23 Cement Concrete Sidewalk Restoration Square Yard 10 24 Cement Concrete Curb and Gutter Restoration Linear Foot 15 25 Temporary Sewer Bypass Pumping/Systems Lump Sum 1 26 Site Demolition and Restoration Lump Sum 1 City of Renton Road Construction NW Engineers Estimate LOW BID Unit Price 28,855.20 24,000.00 14,400.00 3,000.00 3,600.00 18, 000.00 180.00 30, 000.00 3,000.00 2.40 2,400.00 156.00 240.00 1.80 1,800.00 24.00 30.00 156.00 3.60 36.00 180.00 840.00 240.00 150.00 24,000.00 6,000.00 Shoreline Const. Bid Unit Bid Unit Amount Price Amount Price 28,855.20 40,000.00 40,000.00 37,700.00 24,000.00 26,500.00 26,500.00 30,000.00 14,400.00 7,500.00 7,500.00 25,000.00 3,000.00 4,000.00 4,000.00 1,000.00 3,600.00 5,500.00 5,500.00 600.00 18, 000.00 12, 000.00 12, 000.00 100.00 22,500.00 400.00 50,000.00 300.00 30,000.00 52,000.00 52,000.00 70,000.00 3,000.00 4,500.00 4,500.00 10,000.00 1,584.00 12.00 7,920.00 15.00 2,400.00 3,200.00 3,200.00 3,800.00 102,960.00 110.00 72,600.00 130.00 720.00 500.00 1,500.00 450.00 1,188.00 2.00 1,320.00 2.00 1,800.00 4,500.00 4,500.00 6,500.00 4,800.00 35.00 7,000.00 10.00 750.00 125.00 3,125.00 50.00 1,560.00 130.00 1,300.00 100.00 180.00 5.00 250.00 7.00 360.00 50.00 500.00 1.00 4,500.00 300.00 7,500.00 800.00 12,600.00 600.00 9,000.00 850.00 2,400.00 55.00 550.00 80.00 2,250.00 35.00 525.00 40.00 24,000.00 12,000.00 12,000.00 1,000.00 6,000.00 25,000.00 25,000.00 3,000.00 Bid Amount 37,700.00 30,000.00 25,000.00 1,000.00 600.00 100.00 37,500.00 70, 000.00 10,000.00 9,900.00 3,800.00 85,800.00 1,350.00 1,320.00 6,500.00 2,000.00 1,250.00 1,000.00 350.00 10.00 20, 000.00 12,750.00 800.00 600.00 1,000.00 3,000.00 Subtotal 317,407.20 359, 790.00 363,330.00 Tax 9.5% 30,153.68 34,180.05 34,516.35 Total 347,560.88 393,970.05 397,846.35 John D. Hobson From: John D. Hobson Sent: Wednesday, June 10, 2015 12:22 PM To: Garmon Newsom II Subject: Construction Bid Opening Questions Attachments: Special Provision 1-09.14(2)A.pdf; Standard Specification 1-02.13.pdf; Standard Specification 1-03.1.pdf Garmon, The City's Wastewater Utility had a bid opening on Tuesday, June 9"', for the Central Renton Sewer Interceptor Reline and Upsize project. There were a total of four bidders. There appears to be minor irregularities in the two lowest bidders and a major irregularity in the third lowest bidder. Section 1-09.14(2)A "Mobilization and Demobilization" (copy attached) specified that this bid item was not to exceed 10% of the total bid. The low bidders bid amount for this item came in at 11.12% of the total bid. The second low bidder came in at 10.38%. The third low bid was at 25.05% of the total bid price for this item. The third low bid had an additional error in another bid item that changed the respective item's total price from $70,600 to $706 (their unit price was written as $1.07 per linear foot instead of $107 per linear foot; the average for all other bidders for this item was $117.33 per linear foot) which would be considered a major irregularity under Standard Specification 1-02.13 Irregular Proposals subsection 2b. (copy attached). The highest bidder's bid amount was 6.83%. The highest bidders total bid was $86,784.23 higher than the low bid. The requirement to not exceed 10% of the total bid was written by the City to prevent contractors from off-loading project costs onto this one bid item. The Wastewater Utility's opinion is that the low bid (and second low bid) should be considered a minor irregularity and be waived because in the "best interest of the Contracting Agency is served" (Standard Specification 1-03.1 Consideration of Bids, paragraph 2 copy attached). Because of summer weather, timing requirements of our Burlington Northern Railroad Temporary Occupancy Permit and lead time for ordering of specialty items connected with this project, we would like to get this contract on the June 22, 2015 City Council meeting for award. To do this I would like your recommendation by noon this Friday if possible. Let me know if you have any questions. Thank you. City of Renton --r-� E.AfzMO Wastewater Utility 425-430-7279 A,-,AA--v %�oAo GcwSi .�.�Gi long /lil INC. C 1