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CP1819 #19-02 A Street SE Preservation
Washington State Department of Transportation Local Agency Federal Aid Project Prospectus DOT Form 140-101 Page 1 Revised 04/2015 Previous Editions Obsolete Prefix Route ( ) Date May 30, 2018 Federal Aid Project Number DUNS Number 032942575 Local Agency CP1819 WSDOT Federal Employer 91-6001228 Project Number Use Only J Tax ID Number Agency CAAgency Federal Program Title City of Auburn ❑✓ Yes ❑ No ❑✓ 20.205 [:]Other Project Title Start Latitude N 47.30473 Start Longitude W 122.22861 A Street SE Preservation End Latitude N 47.25007 End Longitude W 122.22862 Project Termini From -To Nearest City Name Project Zip Code (+4) 17th St. SE E. Main St. Auburn 98002-4998 Begin Mile Post End Mile Post Length of Project Award Type N/A N/A 0.95 Mile ❑✓ Local ❑ Local Forces ❑ State ❑ Railroad Route ID Begin Mile Point End Mile Point City Number County Number County Name N/A N/A N/A 0055 17 King WSDOT Region Legislative District(s) Congressional District(s) Urban Area Number Northwest Region 30th, 31st, and 47th 8Th 29 Total Local Agency Phase Start Phase Estimated Cost Funding Federal Funds Date Nearest Hundred Dollar Nearest Hundred Dollar Nearest Hundred Dollar Month Year P. E. 198800 99400 99400 June 2018 R/W Const. 1564800 782400 782400 Total 1763600 881800 881800 Description of Existing Facility (Existing Design and Present Condition) Roadway Width Number of Lanes 60 ft on average 5 on average The A St SE corridor is a principle arterial. Between E Main St and 3rd St/Cross St, A St SE is a 3-4 lane roadway with curb/gutter and sidewalk on both sides. Between 3rd St./Cross St, A St SE is a 5 lane roadway with curb/gutter and sidewalk on the east side. Description of Proposed Work Description of Proposed Work (Attach additional sheet(s) if necessary) This project will grind and overlay A Street SE from East Main Street to 17th Street SE, remove unused driveways, and upgrade all curb ramps and pedestrian signals to meet ADA requirements. Local Agency Contact Person Title Phone Kim Truong Project Engineer 253-804-5059 Mailing Address City State Zip Code 25 West Main Street Auburn WA 98001 By o Project Prospectus Approving Authority Title Acting Public Works Director Date &I�! $ DOT Form 140-101 Page 1 Revised 04/2015 Previous Editions Obsolete Agency Project Title Date City of Auburn A Street SE Preservation May 30, 2018 Type of Proposed Work Project Type (Check all that Apply) Roadway Width Number of Lanes ❑ New Construction ❑ Path / Trail ❑ 3-R 60 ft. on avera-e 5 lanes on average ❑✓ Reconstruction ❑ Pedestrian / Facilities ❑ 2-R ❑ Railroad ❑ Parking ❑ Other ❑ Bridge Geometric Design Data Description Through Route Crossroad ❑✓ Principal Arterial ❑ Principal Arterial Federal❑ Minor Arterial ❑✓ Urban El urban ❑ Minor Arterial Functional ❑Collector ❑ Rural 1:1 Rural F-1 Collector Classification ❑ Major Collector NHS E] NHS ❑Major Collector El minor Collector ❑ Minor Collector ❑ Local Access ❑ Local Access Terrain✓❑ Flat [:]Roll ❑Mountain ❑ Flat ❑ Roll ❑ Mountain Posted Speed 40 mph Design Speed 50 mph Existing ADT 30,650 (2017) Design Year ADT 31,000 Design Year 2035 Design Hourly Volume (DHV) 2,925 Performance of Work Preliminary Engineering Will Be Performed By Others Agency Agency 0 % 100 Construction Will Be Performed By Contract Agency Contractor 100 % 0 Environmental Classification ❑ Class I - Environmental Impact Statement (EIS) ✓❑ Class II - Categorically Excluded (CE) ❑ Project Involves NEPA/SEPA Section 404 ❑ Projects Requiring Documentation Interagency Agreement (Documented CE) ❑ Class III - Environmental Assessment (EA) ❑ Project Involves NEPA/SEPA Section 404 Interagency Agreements Environmental Considerations The project improvements will be completed within an existing developed area and no addition right-of-way is required to complete the project. There are no long term environmental impacts anticipated. The City will coordinate with the permitting agencies to assure the project meets the requirements set forth during the State Environmental Policy Act (SEPA) and National Environmental Policy Act (NEPA) processes. DOT Form 140-101 rage z Revised 04/2015 Previous Editions Obsolete Agency Project Title Date City of Auburn A Street SE Preservation May 30, 2018 Right of Way ❑✓ No Right of Way Needed ❑ Right of Way Needed * All construction required by the ❑ No Relocation ❑ Relocation Required contract can be accomplished within the exiting right of way. Utilities Railroad ❑✓ No utility work required ❑✓ No railroad work required ❑ All utility work will be completed prior to the start ❑ All railroad work will be completed prior to the start of of the construction contract the construction contract F-1 All utility work will be completed in coordination ❑AII the railroad work will be completed in coordination with the construction contract with the construction contract Description of Utility Relocation or Adjustments and Existing Major Structures Involved in the Project There are no major utility relocations/adjustments or major structure modification/relocations anticipated for the project. FAA Involvement Is any airport located within 3.2 kilometers (2 miles) of the proposed project? Z Yes ❑ No Remarks The Auburn Municipal Airport is located approximately 1.4 miles from the project site location. The proposed improvements will not have any affect on the Auburn Municipal Airport. This project has been reviewed by the legislative body of the administration agency or agencies, or it's designee, and is not inconsistent with the agency's comprehensive plan for community development. Date Agency City of Auburn By Kul'.. kh hairperson DOT Form 140-101 Page 3 Revised 04/2015 Previous Editions Obsolete Washington State V/ffl Department of Transportation Agency City of Auburn Address 25 West Main St. Auburn, WA 98001 Local Agency Agreement CFDA No. 20.205 (Catalog or Federal Domestic Assistance) Project No. Agreement No. For OSC WSDOT Use Only The Local Agency having complied, or hereby agreeing to comply, with the terms and conditions set forth in (1) Title 23, U.S. Code Highways, (2) the regulations issued pursuant thereto, (3) 2 CFR Part 200, (4) the policies and procedures promulgated by the Washington State Department of Transportation, and (5) the federal aid project agreement entered into between the State and Federal Government, relative to the above project, the Washington State Department of Transportation will authorize the Local Agency to proceed on the project by a separate notification. Federal funds which are to be obligated for the project may not exceed the amount shown herein on line r, column 3, without written authority by the State, subject to the approval of the Federal Highway Administration. All project costs not reimbursed by the Federal Government shall be the responsibility of the Local Agency. Project Description Name A Street SE Preservation Termini 17th St. SE to E Main St. Description of Work Length 0.95 mile This project will grind and overlay A Street SE from East Main Street to 17th Street SE, remove unused driveways, and upgrade all curb ramps and pedestrian signals to meet ADA requirements. Project Agreement End Date December 3l, 2020 Claiming Indirect Cost Rate ❑ Yes �J✓ No Proposed Advertisement Date Estimate of Fundin (1) (2) (3) Type of Work Estimated Total Estimated Agency Estimated Federal Project Funds Funds Funds PE a. Agency $ 113,867.00 $ 15,372.00 $ 98,495.00 o 86.5 �0 b. Other AgencyNon-participating S83,853.00 $ 83,853.00 Federal Aid c. Other Participation d. State $ 1,000.00 $ 135.00 $ 865.00 Ratio for PE e. Total PE Cost Estimate a+b+c+d $ 198,720.00 $ 99,360.00 $ 99,360.00 Right of Way f. Agency o Q. Other Federal Aid h . Other Participation Ratio for RW i. State '. Total RM Cost Estimate f+ +h+i $ 0.00 S 0.00 $ 0.00 Construction k. Contract 1. Other m. Other Federal Aid n. Other Participation o. Agency Ratio for CN p. State q. Total CN Cost Estimate k+l+m+n+o+ $ 0.00 $ 0.00 $ 0.00 r. Total Project Cost Estimate e+i+ $ 198,720.001 $ 99,360.00 $ 99,360.00 Agency Off ici I By Nc Title to Y DOT Form 140-039 Revised 05/2015 Washington State Department of Transportation By Director, Local Programs Date Executed Page 1 Construction Method of Financing (Check Method Selected) State Ad and Award Method A - Advance Payment - Agency Share of total construction cost (based on contract award) Method B - Withhold from gas tax the Agency's share of total construction coast (line 5, column 2) in the amount of $ at $ per month for months. Local Force or Local Ad and Award Method C - Agency cost incurred with partial reimbursement The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a condition to payment of the federal funds obligated, it accepts and will comply with the applicable provisions set forth below. Adopted by official action on May 21 , 2018 , Resolution/Ordinance No. 5369 Provisions I. Scope of Work The Agency shall provide all the work, labor, materials, and services necessary to perform the project which is described and set forth in detail in the "Project Description" and "Type of Work." When the State acts for and on behalf of the Agency, the State shall be deemed an agent of the Agency and shall perform the services described and indicated in "Type of Work" on the face of this agreement, in accordance with plans and specifications as proposed by the Agency and approved by the State and the Federal Highway Administration. When the State acts for the Agency but is not subject to the right of control by the Agency, the State shall have the right to perform the work subject to the ordinary procedures of the State and Federal Highway Administration. Il. Delegation of Authority The State is willing to fulfill the responsibilities to the Federal Government by the administration of this project. The Agency agrees that the State shall have the full authority to carry out this administration. The State shall review, process, and approve documents required for federal aid reimbursement in accordance with federal requirements. If the State advertises and awards the contract, the State will further act for the Agency in all matters concerning the project as requested by the Agency. If the Local Agency advertises and awards the project, the State shall review the work to ensure conformity with the approved plans and specifications. III. Project Administration Certain types of work and services shall be provided by the State on this project as requested by the Agency and described in the Type of Work above. In addition, the State will furnish qualified personnel for the supervision and inspection of the work in progress. On Local Agency advertised and awarded projects, the supervision and inspection shall be limited to ensuring all work is in conformance with approved plans, specifications, and federal aid requirements. The salary of such engineer or other supervisor and all other salaries and costs incurred by State forces upon the project will be considered a cost thereof. All costs related to this project incurred by employees of the State in the customary manner on highway payrolls and vouchers shall be charged as costs of the project. IV. Availability of Records All project records in support of all costs incurred and actual expenditures kept by the Agency are to be maintained in accordance with local government accounting procedures prescribed by the Washington State Auditor's Office, the U.S. Department of Transportation, and the Washington State Department of Transportation. The records shall be open to inspection by the State and Federal Government at all reasonable times and shall be retained and made available for such inspection for a period of not less than three years from the final payment of any federal aid funds to the Agency. Copies of said records shall be furnished to the State and/or Federal Government upon request. V. Compliance with Provisions The Agency shall not incur any federal aid participation costs on any classification of work on this project until authorized in writing by the State for each classification. The classifications of work for projects are: 1. Preliminary engineering. 2. Right of way acquisition. 3. Project construction. Once written authorization is given, the Agency agrees to show continuous progress through monthly billings. Failure to show continuous progress may result the Agency's project becoming inactive, as described in 23 CFR 630, and subject to de -obligation of federal aid funds and/or agreement closure. If right of way acquisition, or actual construction of the road for which preliminary engineering is undertaken is not started by the close of the tenth fiscal year following the fiscal year in which preliminary engineering phase was authorized, the Agency will repay to the State the sum or sums of federal funds paid to the Agency under the terms of this agreement (see Section IX). If actual construction of the road for which right of way has been purchased is not started by the close of the tenth fiscal year following the fiscal year in which the right of way phase was authorized, the Agency will repay to the State the sum or sums of federal funds paid to the Agency under the terms of this agreement (see Section IX). DOT Form 140-039 Page 2 Revised 05/2015 The Agency agrees that all stages of construction necessary to provide the initially planned complete facility within the limits of this project will conform to at least the minimum values set by approved statewide design standards applicable to this class of highways, even though such additional work is financed without federal aid participation. The Agency agrees that on federal aid highway construction projects, the current federal aid regulations which apply to liquidated damages relative to the basis of federal participation in the project cost shall be applicable in the event the contractor fails to complete the contract within the contract time. VI. Payment and Partial Reimbursement The total cost of the project, including all review and engineering costs and other expenses of the State, is to be paid by the Agency and by the Federal Government. Federal funding shall be in accordance with the Federal Transportation Act, as amended, 2 CFR Part 200. The State shall not be ultimately responsible for any of the costs of the project. The Agency shall be ultimately responsible for all costs associated with the project which are not reimbursed by the Federal Government. Nothing in this agreement shall be construed as a promise by the State as to the amount or nature of federal participation in this project. The Agency shall bill the state for federal aid project costs incurred in conformity with applicable federal and state laws. The agency shall minimize the time elapsed between receipt of federal aid funds and subsequent payment of incurred costs. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead shall not be eligible for federal participation unless a current indirect cost plan has been prepared in accordance with the regulations outlined in 2 CFR Part 200 - Uniform Admin Requirements, Cost Principles and Audit Requirements for Federal Awards, and retained for audit. The State will pay for State incurred costs on the project. Following payment, the State shall bill the Federal Government for reimbursement of those costs eligible for federal participation to the extent that such costs are attributable and properly allocable to this project. The State shall bill the Agency for that portion of State costs which were not reimbursed by the Federal Government (see Section IX). 1. Project Construction Costs Project construction financing will be accomplished by one of the three methods as indicated in this agreement. Method A — The Agency will place with the State, within (20) days after the execution of the construction contract, an advance in the amount of the Agency's share of the total construction cost based on the contract award. The State will notify the Agency of the exact amount to be deposited with the State. The State will pay all costs incurred under the contract upon presentation of progress billings from the contractor. Following such payments, the State will submit a billing to the Federal Government for the federal aid participation share of the cost. When the project is substantially completed and final actual costs of the project can be determined, the State will present the Agency with a final billing showing the amount due the State or the amount due the Agency. This billing will be cleared by either a payment from the Agency to the State or by a refund from the State to the Agency. Method B — The Agency's share of the total construction cost as shown on the face of this agreement shall be withheld from its monthly fuel tax allotments. The face of this agreement establishes the months in which the withholding shall take place and the exact amount to be withheld each month. The extent of withholding will be confirmed by letter from the State at the time of contract award. Upon receipt of progress billings from the contractor, the State will submit such billings to the Federal Government for payment of its participating portion of such billings. Method C — The Agency may submit vouchers to the State in the format prescribed by the State, in duplicate, not more than once per month for those costs eligible for Federal participation to the extent that such costs are directly attributable and properly allocable to this project. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead shall not be eligible for Federal participation unless claimed under a previously approved indirect cost plan. The State shall reimburse the Agency for the Federal share of eligible project costs up to the amount shown on the face of this agreement. At the time of audit, the Agency will provide documentation of all costs incurred on the project. The State shall bill the Agency for all costs incurred by the State relative to the project. The State shall also bill the Agency for the federal funds paid by the State to the Agency for project costs which are subsequently determined to be ineligible for federal participation (see Section IX). VII. Audit of Federal Consultant Contracts The Agency, if services of a consultant are required, shall be responsible for audit of the consultant's records to determine eligible federal aid costs on the project. The report of said audit shall be in the Agency's files and made available to the State and the Federal Government. An audit shall be conducted by the WSDOT Internal Audit Office in accordance with generally accepted governmental auditing standards as issued by the United States General Accounting Office by the Comptroller General of the United States; WSDOT Manual M 27-50, Consultant Authorization, Selection, and Agreement Administration; memoranda of understanding between WSDOT and FHWA; and 2 CFR Part 200.501 -Audit Requirements. If upon audit it is found that overpayment or participation of federal money in ineligible items of cost has occurred, the Agency shall reimburse the State for the amount of such overpayment or excess participation (see Section IX). VIII. Single Audit Act The Agency, as a subrecipient of federal funds, shall adhere to the federal regulations outlined in 2 CFR Part 200.501 as well as all applicable federal and state statutes and regulations. A subrecipient who expends $750,000 or more in federal awards from all sources during a given fiscal year shall have a single or program -specific audit performed for that year in accordance with the provisions of 2 CFR Part 200.501. Upon conclusion of the audit, the Agency shall be responsible for ensuring that a copy of the report is transmitted promptly to the State. DOT Form 140-039 Page 3 Revised 05/2015 IX. Payment of Billing The Agency agrees that if payment or arrangement for payment of any of the State's billing relative to the project (e.g., State force work, project cancellation, overpayment, cost ineligible for federal participation, etc.) is not made to the State within 45 days after the Agency has been billed, the State shall effect reimbursement of the total sum due from the regular monthly fuel tax allotments to the Agency from the Motor Vehicle Fund. No additional Federal project funding will be approved until full payment is received unless otherwise directed by the Director, Local Programs. Project Agreement End Date - This date is based on your projects Period of Performance (2 CFR Part 200.309). Any costs incurred after the Project Agreement End Date are NOT eligible for federal reimbursement. All eligible costs incurred prior to the Project Agreement End Date must be submitted for reimbursement within 90 days after the Project Agreement End Date or they become ineligible for federal reimbursement. X. Traffic Control, Signing, Marking, and Roadway Maintenance The Agency will not permit any changes to be made in the provisions for parking regulations and traffic control on this project without prior approval of the State and Federal Highway Administration. The Agency will not install or permit to be installed any signs, signals, or markings not in conformance with the standards approved by the Federal Highway Administration and MUTCD. The Agency will, at its own expense, maintain the improvement covered by this agreement. XI. Indemnity The Agency shall hold the Federal Government and the State harmless from and shall process and defend at its own expense all claims, demands, or suits, whether at law or equity brought against the Agency, State, or Federal Government, arising from the Agency's execution, performance, or failure to perform any of the provisions of this agreement, or of any other agreement or contract connected with this agreement, or arising by reason of the participation of the State or Federal Government in the project, PROVIDED, nothing herein shall require the Agency to reimburse the State or the Federal Government for damages arising out of bodily injury to persons or damage to property caused by or resulting from the sole negligence of the Federal Government or the State. XII. Nondiscrimination Provision No liability shall attach to the State or Federal Government except as expressly provided herein. The Agency shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of any USDOT- assisted contract and/or agreement or in the administration of its DBE program or the requirements of 49 CFR Part 26. The Agency shall take all necessary and reasonable steps under 49 CFR Part 26 to ensure nondiscrimination in the award and administration of USDOT-assisted contracts and agreements. The WSDOT's DBE program, as required by 49 CFR Part 26 and as approved by USDOT, is incorporated by reference in this agreement. Implementation of this program is a legal obligation and failure to carry out its terms shall be treated as a violation of this agreement. Upon notification to the Agency of its failure to carry out its approved program, the Department may impose sanctions as provided for under Part 26 and may, in appropriate cases, refer the matter for enforcement under 18 U.S.C. 1001 and/or the Program Fraud Civil Remedies Act of 1986 (31 U.S. C. 3801 et seq.). The Agency hereby agrees that it will incorporate or cause to be incorporated into any contract for construction work, or modification thereof, as defined in the rules and regulations of the Secretary of Labor in 41 CFR Chapter 60, which is paid for in whole or in part with funds obtained from the Federal Government or borrowed on the credit of the Federal Government pursuant to a grant, contract, loan, insurance, or guarantee or understanding pursuant to any federal program involving such grant, contract, loan, insurance, or guarantee, the required contract provisions for Federal -Aid Contracts (FHWA 1273), located in Chapter 44 of the Local Agency Guidelines. The Agency further agrees that it will be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, that if the applicant so participating is a State or Local Government, the above equal opportunity clause is not applicable to any agency, instrumentality, or subdivision of such government which does not participate in work on or under the contract. The Agency also agrees: (1) To assist and cooperate actively with the State in obtaining the compliance of contractors and subcontractors with the equal opportunity clause and rules, regulations, and relevant orders of the Secretary of Labor. (2) To furnish the State such information as it may require for the supervision of such compliance and that it will otherwise assist the State in the discharge of its primary responsibility for securing compliance. (3) To refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from, or who has not demonstrated eligibility for, government contracts and federally assisted construction contracts pursuant to the Executive Order. (4) To carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the State, Federal Highway Administration, or the Secretary of Labor pursuant to Part II, subpart D of the Executive Order. In addition, the Agency agrees that if it fails or refuses to comply with these undertakings, the State may take any or all of the following actions: (a) Cancel, terminate, or suspend this agreement in whole or in part; (b) Refrain from extending any further assistance to the Agency under the program with respect to which the failure or refusal occurred until satisfactory assurance of future compliance has been received from the Agency; and (c) Refer the case to the Department of Justice for appropriate legal proceedings. DOT Form 140-039 Page 4 Revised 05/2015 XIII. Liquidated Damages The Agency hereby agrees that the liquidated damages provisions of 23 CFR Part 635, Subpart 127, as supplemented, relative to the amount of Federal participation in the project cost, shall be applicable in the event the contractor fails to complete the contract within the contract time. Failure to include liquidated damages provision will not relieve the Agency from reduction of federal participation in accordance with this paragraph. XIV. Termination for Public Convenience The Secretary of the Washington State Department of Transportation may terminate the contract in whole, or from time to time in part, whenever: (1) The requisite federal funding becomes unavailable through failure of appropriation or otherwise. (2) The contractor is prevented from proceeding with the work as a direct result of an Executive Order of the President with respect to the prosecution of war or in the interest of national defense, or an Executive Order of the President or Governor of the State with respect to the preservation of energy resources. (3) The contractor is prevented from proceeding with the work by reason of a preliminary, special, or permanent restraining order of a court of competent jurisdiction where the issuance of such order is primarily caused by the acts or omissions of persons or agencies other than the contractor. (4) The Secretary is notified by the Federal Highway Administration that the project is inactive. (5) The Secretary determines that such termination is in the best interests of the State. XV. Venue for Claims and/or Causes of Action For the convenience of the parties to this contract, it is agreed that any claims and/or causes of action which the Local Agency has against the State of Washington, growing out of this contract or the project with which it is concerned, shall be brought only in the Superior Court for Thurston County. XVI. Certification Regarding the Restrictions of the Use of Federal Funds for Lobbying The approving authority certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any federal agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit the Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, and contracts and subcontracts under grants, subgrants, loans, and cooperative agreements) which exceed $100,000, and that all such subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification as a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. XVII. Assurances Local agencies receiving Federal funding from the USDOT or its operating administrations (i.e., Federal Highway Administration, Federal Transit Administration, Federal Aviation Administration) are required to submit a written policy statement, signed by the Agency Executive and addressed to the State, documenting that all programs, activities, and services will be conducted in compliance with Section 504 and the Americans with Disabilities Act (ADA). Additional Provisions DOT Form 140-039 Page 5 Revised 05/2015 AM Washington State Department of Transportation April 23, 2019 Ms. Ingrid Gaub City Engineer City of Auburn 25 West Main Street Auburn, Washington 98001 City of Auburn A Street SE Preservation STPUL-1069(009) FUND AUTHORIZATION Dear Ms. Gaub: Transportation Building 310 Maple Park Avenue S.E. P.O. Box 47300 Olympia, WA 98504-7300 360-705-7000 TTY:1-800-833-6388 www.wsdot.wa.gov CE BI M APR 29 2019 City of Aubum Pui`lic Worcs Dept We have received FHWA fund authorization, effective April 18, 2019, for this project as follows: PHASE Construction TOTAL $2,269,171 FEDERALSHARE $792,400 The following are required to ensure compliance with federal and state requirements: • Advertisement of the project within six weeks of construction authorization. • Submit the Award Data to the Region Local Programs Engineer prior to construction start. • Show continuous project progress through monthly billings, until the project is complete. Failure to show continuous progress may result in the project becoming inactive per 23 CFR 630.106(a) (5) and subject to de -obligation of all federal funds and agreement closure. Enclosed for your information and file is a fully executed copy of Supplement Number 1 to Local Agency Agreement LA -9397 between WSDOT and your agency. All costs exceeding those shown on this agreement are the sole responsibility of your agency. Any costs incurred after the Project Agreement End Date shown on the supplement are not eligible for federal reimbursement. In addition, all eligible costs incurred prior to the End Date must be billed within sixty (60) days of the End Date or they are ineligible for federal reimbursement. In addition, this supplement modifies your PE funds to a total of $187,160 ($89,360 federal share). You may proceed with the administration of this project in accordance with your WSDOT approved Certification Acceptance agreement. Sincerely, Stephanie Tax Manager, Program Management Local Programs ST:jg:ml Enclosure cc: Mehrdad Moini, Northwest Region Local Programs Engineer, MS NB82-121 Washington State AWk 0 Department of Transportation Local Agency Agreement Supplement Agency Supplement Number City of Auburn 1 Federal Aid Project Number Agreement Number CFDA No. 20.205 STPUL-1069(009) LA 9397 (Catalog of Federal Domestic Assistance) The Local Agency requests to supplement the agreement entered into and executed on June 19, 2018 All provisions in the basic agreement remain in effect except as modified by this supplement. The Local Agency certifies that it is not excluded from receiving Federal funds by a Federal suspension or debarment (2 CFR Part 180). Additional changes to the agreement are as follows: Project Description Name A Street SE Preservation Termini 17th St. SE to E Main St. Description of Work ✓ No Change Reason for Supplement To obligate the constriction fund. Length 0.95 mile Are you claiming indirect cost rate? F-] Yes ✓ No Project Agreement End Date December 31, 2021 Does this change require additional Right of Way or Easements? ❑ Yes ✓ No Advertisement Date: April 23, 2019 The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a condition to payment of the Federal funds obligated, it accepts and will comply with the applicablerovisions. Agency O 'cial Washingto to Departmen f Transportation By By Title Director, Local rogram Date ExecutedAFR .1 ? [Gig DOT Form 140-041 Page 1 Revised 03/2019 Estimate of Fundin (1) (3) (4) (5) Type of Work Previous ( 2) Estimated Total Estimated Agency Estimated Federal A reement/Su I. Supplement Project Funds Funds Funds PE a.Agency 113,867.00 -11,560.00 102,307.00 13,812.00 88,495.00 86.5 % b. Other Agency Non-Participatin 83,853.00 83,853.00 83,853.00 Federal Aid c. Other 0.00 Participation 1,000.00 1,000.00 135.00 865.00 Ratio for PE d. State e. Total PE Cost Estimate a+b+o+d 198,720.00 -11,560.00 187,160.00 97,800.00 89,360.00 Right of Wayo f. Agency 0.00 q. Other 0.00 Federal Aid h. Other 0.00 Participation Ratio for RW i. State 0.00 H. Total RIW Cost Estimate f+ +h+i 0.00 0.00 0.00 0.00 0.00 'Constructiono k. Contract 886,167.00 886,167.00 119,632.00 766,535.00 g6 I. Other Contract Non -Participating 1,302,004.00 1,302,004.00 1,302,004.00 m. Other 0.00 Federal Aid n. Other Agency Non -Participating 51,099.00 51,099.00 51,099.00 Participation Ratio for CN o. A enc 28,901.00 28,901.00 3,901.00 25,000.00 p. State 1,000.00 1,000.00 135.00 865.00 q. Total CN Cost Estimate k+l+m+n+o+ 0.00 2,269,171.00 2,269,171.00 1,476,771.00 792,400.00 Ir. Total Pro'ect Cost Estimate e+'+ 198,720.00 2,257,611.00 2,456,331.00 1,574,571.00 881,760.00 The Local Agency further stipulates that pursuant to said Title 23, regulations and policies and procedures, and as a condition to payment of the Federal funds obligated, it accepts and will comply with the applicablerovisions. Agency O 'cial Washingto to Departmen f Transportation By By Title Director, Local rogram Date ExecutedAFR .1 ? [Gig DOT Form 140-041 Page 1 Revised 03/2019 1� Agency Supplement Number City of Auburn 1 Federal Aid Project Number Agreement Number CFDA No. 20.205 STPUL-1069(009) LA 9397 (Catalog of Federal Domestic Assistance) VI. Payment and Partial Reimbursement The total cost of the project, including all review and engineering costs and other expenses of the State, is to be paid by the Agency and by the Federal Government. Federal funding shall be in accordance with the Federal Transportation Act, as amended, 2 CFR Part 200. The State shall not be ultimately responsible for any of the costs of the project. The Agency shall be ultimately responsible for all costs associated with the project which are not reimbursed by the Federal Government. Nothing in this agreement shall be construed as a promise by the State as to the amount or nature of federal participation in this project. The Agency shall bill the state for federal aid project costs incurred in conformity with applicable federal and state laws. The agency shall minimize the time elapsed between receipt of federal aid funds and subsequent payment of incurred costs. Expenditures by the Local Agency for maintenance, general administration, supervision, and other overhead shall not be eligible for federal participation unless a current indirect cost plan has been prepared in accordance with the regulations outlined in 2 CFR Part 200 - Uniform Admin. Requirements, Cost Principles and Audit Requirements for Federal Awards, and retained for audit. The -State willpayfor State incurred costs on the project. Following payment, the State shall bill the Federal Government for reimbursement of those costs eligible for federal participation to the extent that such costs are attributable and properly allocable to this project. The State shall bill the Agency for that portion of State costs which were not reimbursed by the Federal Government (see Section IX). VII. Audit of Federal Consultant Contracts The Agency, if services of a consultant are required, shall be responsible for audit of the consultant's records to determine eligible federal aid costs on the project. The report of said audit shall be in the Agency's files and made available to the State and the Federal Government. An audit shall be conducted by the WSDOT Internal Audit Office in accordance with generally accepted governmental auditing standards as issued by the United States General Accounting Office by the Comptroller General of the United States; WSDOT Manual M 27-50, Consultant Authorization, Selection, and Agreement Administration; memoranda of understanding between WSDOT and FHWA; and 2 CFR Part 200.501 -Audit Requirements. If upon audit it is found that overpayment or participation of federal money in ineligible items of cost has occurred, the Agency shall reimburse the State for the amount of such overpayment or excess participation. IX. Payment of Billing The Agency agrees that if payment or arrangement for payment of any of the State's billing relative to the project (e.g., State force work, project cancellation, overpayment, cost ineligible for federal participation, etc.) is not made to the State within 45 days after the Agency has been billed, the State shall effect reimbursement of the total sum due from the regular monthly fuel tax allotments to the Agency from the Motor Vehicle Fund. No additional Federal project funding will be approved !until full payment is received unless otherwise directed by the Director, Local Programs. Project Agreement End Date - This date is based on your projects Period of Performance (2 CFR Part 200.309). Any costs incurred after the Project Agreement End Date are NOT eligible for federal reimbursement. All eligible costs incurred prior to the Project Agreement End Date must be submitted for reimbursement within 90 days after the Project Agreement End Date or they become ineligible for federal reimbursement. VIII. Single Audit Act The Agency, as a subrecipient of federal funds, shall adhere to the federal regulations outlined in 2 CFR Part 200.501 as well as all applicable federal and state statutes and regulations. A subrecipient who expends $750,000 or more in federal awards from all sources during a given fiscal year shall have a single or program -specific audit performed for that year in accordance with the provisions of 2 CFR Part 200.501. Upon conclusion of the audit, the Agency shall be responsible for ensuring that a copy of the report is transmitted promptly to the State. XVII. Assurances Local Agencies receiving Federal funding from the USDOT or its operating administrations (i.e., Federal Highway Administration, Federal Transit Administration, Federal Aviation Administration) are required to submit a written policy statement, signed by the Agency Executive and addressed to the State, documenting that all programs, activities and services will be conducted in compliance with Section 504 and the Americans with Disabilities Act (ADA). DOT Form 140-041 Page 2 Revised 03/2019 CITY OF AiJI1J r* Nancy Backus,Mayor WASHINGTON 25 West Main Street * Auburn WA 98001-4998 * www.au bu rnwa.gov * 253-931-3000 June 5, 2019 CERTIFIED MAIL RETURN RECEIPT REQUESTED Jamie Osborn Pivetta Brothers Construction, Inc. 1812 Pease Avenue Sumner, WA 98390 RE: Contract No. 19-02 Project No. CP1819, A Street SE Preservation Federal Aid #STPUL-1069(009) Letter of Award Dear Mr. Osborn: Bids for construction of the above-referenced project were opened by the City Clerk at Auburn City Hall on Wednesday, May 22, 2019 at 11:00 AM. Two (2) responsive bids were received and have been tabulated. Your firm submitted the lowest responsible bid. The total award amount including Washington State sales tax (if applicable) is two million, two hundred and eighty-nine thousand, six hundred and ninety-four dollars and ninety-nine cents ($2,289,694.99). The City Council, at their meeting on June 3, 2019, approved award of the project to your firm. This letter serves as your notice of award for the subject project and is a contract specification. It is the policy of the United States Department of Transportation and the City of Auburn that Underutilized Disadvantaged Business Enterprises (UDBE), as defined in the specifications for this contract, shall have the maximum opportunity to participate in the performance of contracts financed in whole or in part with federal funds. Consequently, (except as specifically provided in the specifications for this contract)the requirements of 49 CFR 26 applies to this contract. Please execute and return the following contract documents and other required information to the attention of Jenny Sebero, Contracts Administration Specialist, within seven calendar days after receiving this letter of award: a) Contract, in duplicate; b) Contract Bond, in duplicate; c) Power of Attorney for your bonding company; d) Certificate(s) of insurance naming the City of Auburn as additional insured, in duplicate, for all required insurance coverages. Please include the Contract Number, Project Number and Project Name on the certificate(s). A pre-construction conference (pre-con) has been scheduled for Thursday, June 20, 2019 at 11:00 AM in Conference Room #1, located on the second floor of One East Main Street, Auburn. ENG-090, Revised 12/18 AUBURN * MORE THAN YOU IMAGINED Pivetta Brothers Construction, Inc. June 4, 2019 Page 2 of 2 The City requires that the Contractor have the appropriate personnel at the pre-construction meeting. This would include, at a minimum, the project manager and the on-site superintendent. The Contractor is encouraged to include any of their staff or sub-contractor staff they feel are critical to the project. The Contractor shall submit electronically one (1)day prior to the pre-construction meeting: a) Preliminary Progress Schedule for the first 30 working days; b) Breakdown of lump sum items; except for Traffic Control Supervisor and Mobilization; c) Preliminary schedule of submittals. Please bring the following items to the pre-construction meeting: a) Requests to sublet work for all subcontractors and lower tier subcontractors; b) Emergency call list; c) A schedule of equipment and labor rates, as outlined in Section 1-09.6(Force Account) to be utilized in the event of any Force Account activities. As noted in the contract documents, a Notice to Proceed will be issued within five working days of the contract execution date, which is the date the contract has been fully executed by the City. If you do not have a current Business License to work in the City of Auburn, an application has been included and should be returned to the Customer Service Center, One East Main Street, Auburn as soon as possible. All subcontractors and lower tier subcontractors working on the project must also have a City of Auburn Business License. Please contact me at 253-804-5059 or Jenny Sebero, Contracts Administration Specialist, at 253-931-3012, if you have any questions. Sincerely, Ism Truong Project Engineer Public Works Department KT/js/as Enclosures cc: Shawn Campbell, City Clerk Josh Linkem, Construction Inspector File 13.11 (CP1819) ENG-090, Revised 12/18 * * CITY OF AUBURN Nancy Backus, Mayor WASHINGTON 25 West Main Street* Auburn WA 98001-4998 * www.auburnwa.gov * 253-931-3000 July 10, 2019 CERTIFIED MAIL RETURN RECEIPT REQUESTED Candy Riordan Pivetta Brothers Construction, Inc. 1812 Pease Avenue Sumner, WA 98390 NOTICE TO PROCEED RE: CP1819, A Street SE Preservation, Contract#19-02 You are hereby notified to proceed as of July 12, 2019 with the work on the above- referenced project, within the time period specified, in accordance with the provisions of the i contract documents, copy enclosed. Your first working day will be July 15, 2019.This project has 80 working days for completion. If you have any questions, please contact the inspector for the project, Josh Linkem at 253-876-1926 or the Contract Administration Specialist, Jenny Sebero at 253-931-3012. Sincerely, Kim Truong Project Engineer Public Works Department KT/js/as Enclosure cc: Shawn Campbell, City Clerk Jacob Sweeting, Assistant Director of Engineering/City Engineer Josh Linkem, Project Inspector File 13.11 (CP1819) ENG-017, Revised 12/18 AUBURN * MORE THAN YOU IMAGINED CONTRACT Contract No. 19-02 THIS AGREEMENT AND CONTRACT, made and entered into, in duplicate, at Auburn, Washington, this ID day of , 20 141 by and between the CITY OF AUBURN, WASHINGTON, a munikipal corporation, and PIVETTA BROTHERS CONSTRUCTION, INC., hereinafter called the CONTRACTOR. WITNESSETH: That, in consideration of the terms and conditions contained in the Contract Documents entitled "CP1819, A Street SE Preservation," which are by this reference incorporated herein and made a part of this Contract, the parties hereto covenant and agree as follows: I. The CONTRACTOR shall do all work and furnish all tools, materials and equipment for Project CP1819, A Street SE Preservation—grind, repair, and overlay the roadway; upgrade curb ramps; replace manholes and catch basins' frame and cover; install traffic vehicle detection cameras; replace water main and applicable appurtenances for a bid price of two million, two hundred and forty-six thousand, three hundred and twenty dollars and fifty-five cents ($2,246,320.55) and Washington State Sales Tax of forty-three thousand, three hundred and seventy-four dollars and forty- four cents ($43,374.44) for a total contract value of two million, two hundred and eighty-nine thousand, six hundred and ninety-four dollars and ninety-nine cents ($2,289,694.99) in accordance with and as described in the Contract Documents which are by this reference incorporated herein and made a part hereof, and shall perform any alterations in or additions to the work provided under this Contract and every part thereof. This Contract shall be executed by the Contractor and returned to the City within seven (7) calendar days after the receipt of the dated notification of award and the Contract time shall commence within five (5) working days after execution of the Contract by the City and so designated on the Notice to Proceed. Physical completion shall be within 80 working days of the date on the Notice to Proceed. If said work is not completed within the time specified, the CONTRACTOR agrees to pay liquidated damages to the CITY OF AUBURN, as specified in Section 1-08.9 (Liquidated Damages) of the Standard Specifications. The CONTRACTOR shall provide and bear the expense of all equipment, work and labor of any sort whatsoever that may be required for the transfer of materials and for constructing and completing the work provided for in this Contract and every part thereof, except such as are mentioned in the Contract Documents to be furnished by the CITY OF AUBURN. II. The CITY OF AUBURN hereby promises and agrees with the CONTRACTOR to employ, and does employ the CONTRACTOR to provide the materials and to do and cause to be done the above described work and to complete and finish the same according to the Contract Documents and the terms and conditions herein contained and hereby contracts to pay for the same according to said Contract Documents and the aforesaid proposal hereto attached, at the time and in the manner and upon the conditions provided for in this Contract. III. The CONTRACTOR for himself, and for his heirs, executors, administrators, successors, and assigns, does hereby agree to the full performance of all the covenants herein contained upon by part of the CONTRACTOR. IV. It is further provided that no liability shall attach to the CITY OF AUBURN, WASHINGTON by reason of entering into this Contract, except as expressly provided herein. IN WITNESS WHEREOF the parties hereto have caused this Contract to be executed the day and year first hereinabove written. CITY OF AUBURN, WASHINGTON By N ckus, Mayor Countersigned: this 10 day of Sal , 20 19 APPROVED AS TO FORM: on \ at\ evst�e Gross, City Attorney PIVETTA BROTHER CO TRUCTION, INC. By " ri 11,I Authorized Official Signature CONTRACT BOND CONTRACT NO. 19-02 BOND NO. 2285407 BOND TO CITY OF AUBURN, WASHINGTON KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, PIVETTA BROTHERS CONSTRUCTION, INC., as principal, and North American Specialty Insurance Company ,a corporation, organized and existing under the laws of the State of New Hampshire as a surety corporation, and qualified under the laws of the State of Washington to become surety upon bonds of contractors with municipal corporations, as surety, are jointly and severally held and firmly bound to the City of Auburn, Washington, in the penal sum of Two million two hundred eighty nine thousand six hundred ninety four and 99/100($2,289,694.99) dollars, for the payment of which sum we jointly and severally bind ourselves and our successors, heirs, administrators or personal representatives as the case may be. This obligation is entered into in pursuance of the Statutes of the State of Washington and the Ordinances of the City of Auburn Washington. O, Dated at Auburn,Washington,this 1 C) day of S Ld , 20 I /. Nevertheless, the conditions of the above obligation are suh that: WHEREAS, the City of Auburn on the 3rd day of June, 2019, let to the above bounden principal a certain Contract. The said Contract being numbered 19-02, and providing for the construction of Project CP1819, A Street SE Preservation-grind, repair, and overlay the roadway; upgrade curb ramps; replace manholes and catch basins' frame and cover; install traffic vehicle detection cameras; replace water main and applicable appurtenances (which Contract is referred to herein and is made a part hereof as though attached hereto), and WHEREAS, the said principal has accepted, or is about to accept, the said Contract, and undertake to perform the work therein provided for in the manner and within the time set forth: NOW, THEREFORE, if the above bounden principal shall faithfully and truly observed and comply with the terms, conditions, and provisions of said Contract in all respects and shall well and truly and fully do and perform all matters and things by them undertaken to be performed under said Contract, upon the terms proposed therein, and any and all duly authorized modifications of said Contract that may hereafter by made, and within the time prescribed therein, and until the same is accepted, and shall pay all laborers, mechanics, subcontractors and material men, and all persons who shall supply principal or subcontractors with provisions and supplies for the carrying on of said work and shall hold said City of Auburn, Washington, harmless from any loss or damage occasioned to any person or property by reason of any carelessness or negligence on the part of said principal or any subcontractor in the performance of said work, and shall in all respects faithfully perform said Contract according to law, and shall indemnify and hold the City of Auburn, Washington, harmless from any damage or expense by reason of failure of performance, as specified in said Contract, and The undersigned principal and the undersigned surety present this contract bond related to the Contract, PROVIDED that this document shall not be enforceable unless and until the City of Auburn awards and executes the Contract to the undersigned principal. No obligations under this bond,for the performance of the above-referenced contract, shall be enforceable until the City of Auburn has executed the contract to the undersigned principal. The Surety, hereby agrees that modifications and changes may be made in the terms and provisions of the aforesaid Contract without notice to Surety, and any such modifications or changes increasing the total amount to be paid the Principal shall automatically increase the obligation of the Surety on this Contract Bond in a like amount, such increase; however, not to exceed twenty — five percent (25%) of the original amount of this bond without the consent of the Surety. PROVIDED, however, that 60 days after the Completion of this Contract, the expiration of the lien period, and if there are no liens pending, and provided the conditions of the release of Contract Bond as provided in the Contract are met, THEN and in that event this obligation shall be void; but otherwise it shall be and remain in full force and effect. It is hereby expressly agreed that if any legal action is necessary to be brought under the conditions of this bond,that the decisions of the Courts of the State of Washington shall be binding. IN WITNESS WHEREOF, the above- o den parties have exe ted this instrument this I C day of ll , 20 ' . Pivdtta1Brothe ons ctio , nc. Principal North American Specialty Insurance Company Surety B -�. Y Attorney in Fact Patti White PO Box 3018 Bothell,WA 98041-3018 425-489-4500 Resident Agent's Address&Phone Number SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Kansas City,Missouri and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Kansas City,Missouri,and Westport Insurance Corporation,organized under the laws of the State of Missouri,and having its principal office in the City of Kansas City,Missouri does hereby make,constitute and-appoint: THERESA A.LAMB,JIM W.DOYLE,CHAD M.EPPLE,JULIE M.GLOVER,JIM S.KUICH,MICHAEL A.MURPHY, ANDY D.PRILL,STEVE WAGNER,AND PATTI WHITE JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." aualw � Q401/...... 'VS////moi a� /SftPO•61,4, A}l t rp;p41PO .j.!/y AP 1�4:GO Rfj.,G. s By 1 iNc� �"r SEAL tt':b Steven P.Anderson,Senior Vice President of Washington International Insurance Company i t�1 % `t i SEAL g O=e u�Jl '• .`Z0 I &Senior Vice President of North American Specialty Insurance Company t SEAL =Q. 1973n` &Senior Vice President of Westport Insurance Corporation t! •••,,.. • ar /l 1111111N� 4 b4uorcv Viol J By l f �'�'";SW;. . ,0 /y Ef Mike A.Ito,Senior Vice President of Washington International Insurance Company &Senior Vice President of North American Specialty Insurance Company &Senior Vice President of Westport Insurance Corporation IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 12TH day of FEBRUARY ,20 19 North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook ss: On this 12THday of FEBRUARY,20 19,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL _ a ,`�� \rk M.KENNY Nouty Public-State td lliinais My ' Commission 12 o `a oi,'" "s • M.Kenny,Notary Public, I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this day of ifi.,4•11 ,20 / /. Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company& North American Specialty Insurance Company&Vice President&Assistant Secretary of Westport Insurance Corporation Page 1 of 7 98 Shares North American Specialty Insurance Co (a member of Swiss Reinsurance Group) AM Best#: 001866 NAIC#: 29874 FEIN#: 02-0311919 Address: 1200 Main Street Suite 800 Kansas City, MO 64105 UNITED STATES Phone: 816-235-3700 Fax: 816-235-3738 Web: www.swissre.com Follow i i Print this page Best's Credit Ratings Financial Strength Rating View Definition Rating: A+ (Superior) Affiliation Code: g (Group) Financial Size Category: XV ($2 Billion or greater) Outlook: Stable Action: Affirmed Effective Date: December 13, 2018 Initial Rating Date: June 30, 1984 Long-Term Issuer Credit Rating View Definition Long-Term: aa Outlook: Stable Action: Affirmed Effective Date: December 13, 2018 Initial Rating Date: August 23, 2006 http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=001866&PPP= 6/24/2019 Page 2 of 7 iu Denotes Under Review Best's Rating 1 Licensing: Licensed Territory: (Current since 05/21/2012).The company is licensed in the District of Columbia, Puerto Rico and all states. http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=001866&PPP= 6/24/2019 Page 1 of 2 Consumer tools Agent and Company Lookup Orders Independent Review Decisions NORTH AMERICAN SPECIALTY INSURANCE COMPANY Change History I Licensing, I Appointments I Complaints I Orders I National Info I Ratings I Tax Filings Back to Search General information Contact information Name: NORTH AMERICAN SPECIALTY INSURANCE Registered address Mailing address COMPANY 650 ELM ST Corporate family group: SWISS RE GRP 0 MANCHESTER, NH 03101- 1200 MAIN ST STE 800 Organization type: PROPERTY 2524 KANSAS CITY, MO 64105 Doing Business As (DBA): Unavailable Telephone Telephone WAOIC: 965 603-644-6600 816-235-3700 NAIC: 29874 Status: ACTIVE Admitted date: 03/08/1985 Ownership type: STOCK back to top Company change history o View changes back to top Types of coverage authorized to sell o Insurance types Casualty Disability 'Marine Ocean Marine Property 'Surety (Vehicle back to top Agents and agencies that represent this company (Appointments) o View agents View agencies back to top Company complaint history o https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=965 6/24/2019 Page 2 of 2 View complaints Orders issued since 2010 No orders are found .4f?4.k.SRAQP. Premium tax filings by tax year o 2018 2017 2016 2015 2014 M back to top National information on insurance companies Want more information about this company?The NAIC's Consumer Information (CIS) page allows you to retrieve national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. 4.D ck to Spp Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability. Some of these companies charge for their services. A.M. Best 'Weiss Group Ratings Standard and Poor's Cork Moody's Investors Service 'Fitch IBCA, Duff and Phelps Ratings Disdaimer:Links to external or third-party websites are provided solely for visitors'convenience.Links you take to other sites are done so at your own risk and our office accepts no liability for any external linked sites or their content.Be aware that not all financial rating companies use the same rating processes. t back to top https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=965 6/24/2019 �„..--.N PIVEBRO-01 LMORELOS A�RST CERTIFICATE OF LIABILITY INSURANCE DA6/13/2019 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CQNTNAME:ACT Hub International Northwest LLC arcC,NNo,Ext):(425)4894500 I FAx )485-8489 P.O.Box 3018 (NC,No):(425 Bothell,WA 98041 UbRlEss:now.info a@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:BITCO General Insurance Corporation 20095 INSURED INSURER B: , Pivetta Brothers Construction,Inc. INSURER C: 1812 Pease Avenue _INSURER D: Sumner,WA 98390 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 VNTH 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS -,LTR ,INSD-WVD IMM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X CLP3679118 3/1/2019 3/1/2020 PREMISES(Ea occu7ence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGRE ATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PR LOC PRODUCTS-COMP/OP AGG _$ 2,000,000 OTHER: STOP GAP $ 1,000,000 A AUTOMOBILE LIABIUTY (Ea accicidentSINGLE LIMIT $ 1,000,000 X ANY AUTO X X CAP3679120 3/1/2019 3/1/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSREONLY AUTOS BODILY BODILY INJURYp (Per accident) $ X AUTOS ONLY X AUTOS ONLY (Per accede^t)AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 1,000,000 EXCESS UAB CLAIMS-MADE CUP2815808 3/1/2019 3/1/2020 AGGREGATE $ 1,000,000 DEC X RETENTION$ 10,000 $ A WORKERS ND EMPLOY RS'LIABILITY COMPENSATION STATUTE R X ERH CLP3679118 3/1/2019 3/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ FFICER/MEM RR EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Project No.CP1819,A Street SE Preservation City of Auburn,its officers,elected officials,employees,agent and volunteers are included as an Additional Insured,coverage is primary and non-contributory and waiver of subrogation applies per the attached forms/endorsements CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Of Auburn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 25 West Main St Auburn,WA 98001 AUTHORIZED REPRESENTATIVE� / ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy#CLP3679118 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — ONGOING OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for"bodily injury" or"property damage" caused, in whole or in part, by"your work"at the project designated in the contract, performed for an additional insured and which occurred during your ongoing operations for that additional insured. If the written contract or an additional insured endorsement required by the written contract requires that the additional insured be provided with coverage for"bodily injury" or"property damage"caused solely by their own negligence, then Section II —Who is An Insured cited immediately above does not apply and is replaced by: Section II — Who is An Insured is amended to include as an additional insured any person or organization required by the written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury" or "property damage" arising out of "your work" at the project designated in the contract, performed for an additional insured and which occurred during your ongoing operations for that additional insured. Regardless of which of the aforementioned Section II —Who is An Insured amendments is applicable to the additional insured, the insurance afforded to the additional insured: 1. will only apply if the written contract requiring additional insured coverage was signed into effect by you and an additional insured prior to any"bodily injury"or"property damage" occurring for which this coverage is sought; and 2. will only apply to the extent not prohibited by the law governing the project; and 3. will not apply to"bodily injury"or"property damage"occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the "bodily injury" or "property damage" arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. The Limits of Insurance applicable to the additional insured under this endorsement are the minimum limits specified in the written contract requiring this coverage, or as stated in Section III — Limits of Insurance of the Commercial General Liability Coverage Form, whichever is less. These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance described in Section III of that form. This insurance is excess of all other insurance available to the additional insured, whether excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designates the additional insured as a Named Insured and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance which the additional insured qualifies as an insured or additional insured, this insurance will be excess. Includes copyrighted material of Insurance Services Office, Inc.with its permission GL-5058 (10/16) Policy#CLP3679118 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed operations, but only with respect to liability for"bodily injury" or"property damage" caused, in whole or in part, by"your work" at the project designated in the contract, performed for an additional insured and included in the"products-completed operations hazard". If the written contract or an additional insured endorsement required by the written contract requires that the additional insured be provided with coverage for"bodily injury" or"property damage" caused solely by their own negligence, then Section II—Who is An Insured cited immediately above does not apply and is replaced by: Section II — Who is An Insured is amended to include as an additional insured any person or organization required by the written contract to be an additional insured on your policy for completed operations, but only with respect to liability for"bodily injury" or"property damage" arising out of"your work" at the project designated in the contract, performed for an additional insured and included in the "products-completed operations hazard". Regardless of which of the aforementioned Section II—Who is An Insured amendments is applicable to the additional insured, the insurance afforded to the additional insured: 1. will only apply if the written contract requiring additional insured coverage was signed into effect by you and an additional insured prior to any"bodily injury" or"property damage" occurring for which this coverage is sought; and 2. will only apply to the extent not prohibited by the law governing the project; and 3. will not apply to "property damage" in connection with a project where "your work" on the project was completed and where the duration of the additional insured coverage requirement in the written contract governing "your work" on that project had expired by the time that "property damage"first occurred; and 4. will not apply to "property damage" in connection with a project where "your work" on the project was completed and where the "property damage" occurred after the minimum time required for completed operations coverage in the written contract, if any, has expired. The Limits of Insurance applicable to the additional insured under this endorsement are the minimum limits specified in the written contract requiring this coverage, or as stated in Section III — Limits of Insurance of the Commercial General Liability Coverage Form, whichever is less. These Limits of Insurance are inclusive of and not in addition to the Limits of Insurance described in Section III of that form. This insurance is excess of all other insurance available to the additional insured, whether excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designates the additional insured as a Named Insured and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance which the additional insured qualifies as an insured or additional insured, this insurance will be excess. Includes copyrighted material of Insurance Services Office, Inc. with its permission GL-5057(10/16) Policy#CLP3679118 insurance is available to you for "your work" in connection with your interest in such partnership or joint venture. B. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE—ONGOING OPERATIONS SECTION II — WHO IS AN INSURED is an-ended to indude as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part,by: 1. Your acts or orrissions; or 2. The acts or orrissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the project(s) designated in the written contract. With respect to the insurance afforded to these additional insureds, the following additional exdusions aPPly This insurance does not apply to"bodily injury'or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been oorrpleted;or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the sane project. This insurance is excess of all other insurance available to the additional insured,whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Nan-ed Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. C AUTOMATIC WAIVER OF SUBROGATION Item& of SECTION IV-CONNERCIAL GENERAL UABILRY CONOn1ONS, is deleted and replaced with the following: a Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of"your work"for that person or organization. D. EXTETDED NOTICE OF CANCELLATION,NONRENEWAL Item A.2b. of the COMMON POLICY CONDITIONS , is deleted and replaced with the following: Alb. 60 days before the effective date of the cancellation if we cancel for any other reason. GL-3085(09/11) -2- Policy#CLP3679118 M CONSTRUCTION PROJECT GENERAL AGGREGATE UMTS This modifies SECTION III-UMTS OF INSURANCE . A. For all sums which can be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an"occurrence"under SECTION I-COVERAGE A and for all medical expenses caused by accidents under SECTION I -COVERAGE C: 1. A separate Construction Project General Aggregate Unit applies to each construction project, and that limit is equal to the amount of the General Aggregate Unit shown in the Declarations. 2. The Construction Project General Aggregate Unit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury' or "property damage" included in the "products-completed operations hazard," and for medical expen—os under COVERAGE C regardless of the nurrber 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 Construction Project General Aggregate Unit for that construction project. Such payments shall not reduce the General Aggregate Unit shown in the Dedarations nor shall they reduce any other Construction Project General Aggregate Unit for any other construction project. 4. The limits shown in the Dedarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Unit shown in the Dedarations, such limits will be subject to the applicable Construction Project General Aggregate Unit. B. For all sums which cannot be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an "occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I-COVERAGE C : 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 Unit or the Products-Completed Operations Aggregate Unit,whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Unit. C. Payments for damages because of "bodily injury' or"property damage" included in the "products- completed operations hazard" will reduce the Products-Completed Operations Aggregate Unit, and not reduce the General Aggregate Unit nor the Construction Project General Aggregate Unit. D. If a construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E The provisions of SECTION III - UMTS OF INSURANCE not otherwise modified by this endorsement shall continue to be applicable. N. FELLOW EMPLOYEE COVERAGE GL-3085(09/11) -6- Policy#CAP3679120 BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE CCMPANY THS ENDORSENQJT CHANGES THE POLICY. PLEASE READ TT CAREFULLY. BROADENED COVERAGE-AUTOMOBILES The following modifies insurance provided under: BUSINESS AUTO COVERAGE FORM Wth respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. 1 - Broad Form Named Insured 11 - Bodily Injury Extension 2- Automatic Waiver of Subrogation 12- Fired Auto Physical Damage 3- Automatic Additional Insured 13- Enhanced Supplementary Payments 4- Primary and Noncontributory-Other Insurance 14- Fellow Employee Coverage for Designated Condition Positions 5- Unintentional Failure to Disclose Hazards 15- Physical Damage—Transportation Expenses 6- Extended Notice of Cancellation, Non-Renewal 16- Rental Reimbursement Coverage 7- When We Do Not Renew 17- Loa /Lease Gap Coverage 8- Notice of Knowledge of Accident or Loss 18- Accidental Air Bag Discharge Coverage 9- Employees as Insured 19- Gass Repair—Waiver of Deductible 10- Employee Hired Autos 1. BROAD FORM NAKED INSURED SECTION II.A 1.-WHO IS AN INSURED -Paragraph d. is added: d. Any organization you newly acquire or form, except for a partnership, joint venture or limited liability company, and over which you maintain majority ownership or interest (51%or more)or for which you have assumed the active management, will qualify as a Named Insured if there is no other similar insurance available to that organization. However, coverage under this provision is only afforded until the end of the policy period or the 12-month anniversary of the policy inception date,whichever is earlier. 2. AUTOMATIC WAIVER OF SUBROGATION Section IV— Business Auto Conditions, Paragraph A5., Transfer of Rights of Recovery Against Others to Us, is deleted and replaced with the following: a If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for damages under this coverage form AP-0401 (10/17) -1- a AUTOMAl1C ADDITIONAL INSURED SECTION II — WHO IS AN INSURED, Paragraph Al, is amended to include as an "insured" any person or organization who is required by written contract or agreement to be an additional insured on your policy, but only with respect to liability arising out of operations performed by you or on your behalf for the additional insured. 4. PRIMARY AND NONCONTRIBUTORY-OTHER INSURANCE CONDITION The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Lability Coverage is primary to and will not seek contribution from any other insurance available to an"insured"under your policy provided that: 1. Such"insured"is a Named Insured under such other insurance;and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such"insured". 5. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. 6. EXTENDED NOTICE OF CANCELLATION,NON-RENEWAL The COMMON POUCY CONDfT10NS , Item A2.b. is deleted and replaced with the following: A2b. 60 days before the effective date of the cancellation if we cancel for any other reason. 7. WHEN WE DO NOT RENEW SECTION IV—BUSINESS AUTO COMMONS , is amended to add Item B.9.: a If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a above, it is agreed that you may extend the period of this policy for a maximum additional sixty (60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one-time sixty-day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a above. a NOTICE OF KNOWLEDGE OF ACCIDENT OR LOSS SECTION IV-BUSINESS AUTO CONDITIONS , Item A2a is deleted and replaced with the following: 2. Duties in the Event of Accident,Claim Suit or Loss: a You must see to it that we are notified of an "accident", "daim" "suit" or "loss" which may result in a daim as soon as practicable after the "occurrence" has been reported to you, a partner, a member, an officer, or an employee designated to give notice to us. Notice should include: (1) How,when and where the"accident"or"loss"occurred; AP-0401 (10/17) -2- (2) The"insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. 9. EMPLOYEES AS INSURED The following is added to the Section II - Covered Autos Liability Coverage, Paragraph Al. Who Is An Insured provision: Any"employee"of yours is an"insured"while using a covered"auto"you don't own, hire or borrow in your business or your personal affairs. 10. EMPLOYEE FIRED AUTOS A Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. B. Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph 5.f. of the Other Insurance-Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: 1. Any covered'auto"you lease, hire, rent or borrow,and 2. Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. However,any"auto"that is leased, hired, rented or borrowed with a driver is not a covered"auto". 11. BODILY INJURY BGENSION SECTION V-DEFINII1ONS , Paragraph C. is deleted and replaced by the following: C. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish or death resulting from any of these, at any time. Mental anguish means any type of mental or emotional illness or disease. 12. FIRED AUTO PHYSICAL DAMAGE SECTION III.A4.- Coverage Extensions -Paragraph c. is added: c. fired Auto Physical Damage If Comprehensive, Specified Causes of Loss or Collision coverage is provided under this policy, then Hired Auto Physical Damage is provided for that coverage part subject to the following: (1) The most we will pay for any one "accident" or "loss" under this Hired Auto Physical Damage Coverage is the lesser of: (a) The any one"Accident"or"Loss"amount of$100,000; (b) The actual cash value; or AP-0401 (10/17) -3- (c) Cost of repair. Our obligation to pay for a loss in c.(1) above will be reduced by a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. The deductible will be waived for"loss"caused by fire or lightning. (2) Subject to paragraph c.(1). above, we will provide coverage equal to the broadest physical damage coverage applicable to any covered"auto"shown in the dedarations. (3) When you are required by written contract to indemnify a lessor for actual financial loss because of loss of use of a hired"auto"resulting from a covered"accident"or"loss",we will cover that financial loss subject to the lirrit specified in paragraph c.(1). 13. ENHANCED SUPPLENVENTARY PAYIUIENfS SECTION II.A2.a COVERAGE EXTENSIONS, Supplementary Payments (2) and (4) are replaced by the following: (2) up to$2,500 for the cost of bail bonds (including bonds for related traffic laws violations) required because of an"accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenccs incurred by the"insured" at our request, including actual loss of earnings up to$350 a day because of time off from work. 14. FELLOW EMPLOYEE COVERAGE FOR DESIGNATED POSITIONS The Fellow Employee Exclusion contained in Section II.B.5. does not apply to the following positions or job titles: foreman, supervisor, manager, officer, partner or other senior level"employee". Coverage is excess over all other collectible insurance. 15. PHYSICAL DAMAGE-TRANSPORTATION E)(PENSES SECTION III.A4.a Transportation Expenses is replaced by the following: a Transportation Expenses We will pay up to$50 per day to a maximum of$1,500 for terrporary transportation expense incurred by you because of the total theft of a covered "auto". We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Cause of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expirations,when the covered"auto"is returned to use or we pay for its"loss". For autos provided with terrporary transportation expense, the following physical damage coverage will aPPIy (1) The most we will pay for any one"accident"or"loss"under the temporary transportation expense physical damage coverage is the lessor of: (a) The any one"Accident"or"Loss"amount of$100,000; (b) The actual cash value; or (c) Cost of repair. Our obligation to pay for a loss in a(1) above will be reduced by a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. The deductible will be waived for"loss"caused by fire or lightning. AP-0401 (10/17) -4- (2) Subject to paragraph a(1). above, we will provide coverage equal to the broadest physical damage coverage applicable to any covered"auto"shown in the declarations. (3) Wien you are required by written contract to indemnify a lessor for actual financial loss because of loss of use of a hired "auto" resulting from a covered "accident" or "loss", we will cover that financial loss subject to the limit specified in paragraph a(1). 16. RENTAL RBNBURSEIVENT COVERAGE SECTION III.A4.-Coverage Extensions - Paragraph d. is added. d If you carry Comprehensive, Specified Causes of Loss or Collision coverage for the damaged covered "auto" as provided under this policy, then Rental Reimbursement Coverage is provided for that coverage part subject to the following: 1. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" other than theft, to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. 2. We will only pay for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the polies expiration, with the lesser of the following number of days: (a) The number of days reasonably required to repair or replace the covered"auto";or, (b) 30 days. (c) Our payment is limited to the lesser of the following amounts: (1) Necessary and actual expenses incurred; or (2) $50 per day. 17. LOAN/LEASE GAP COVERAGE Physical Dar age Coverage is amended by the addition of the following: In the event of a total "loss" to a covered "auto", we will pay your additional legal obligation for any difference between the actual cash value of the "auto" at the time of the loss and the "outstanding balance"of the loan/lease, not to exceed$2,500 for any one vehide or$25,000 annually in aggregate. For the purposes of this endorsement, "outstanding balance" means the amount you owe on the loan/lease at the time of loss less any amounts representing taxes, overdue payments, penalties, interest or charges resulting from overdue payments, additional mileage charges, excess wear and tear charges or lease termination fees, costs for extended warranties, credit Life Insurance; Health, Accident or usability Insurance purchased with the loan or lease; and carry-over balances from previous loans or leases. 18. ACCIDENTAL AIR BAG DISCHARGE COVERAGE SECTION III.B.3.a-Exclusions .This exclusion does not apply to the accidental discharge of an air bag. 19. GLASS REPAIR-WAIVER OF DEDUCTIBLE SECTION III.D-Deductible is replaced with the following: For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to"loss" caused by fire or lightning. The deductible does not apply to glass damage if the glass is repaired rather than replaced. AP-0401 (10/17) -5- Page 1 of 7 98 Shares BITCO General Insurance Corp (a member of Old Republic Insurance Group) AM Best#: 002075 NAIC#: 20095 FEIN#: 36-0810360 Address: 3700 Market Square Circle Davenport, IA 50807-2309 UNITED STATES Phone: 800-475-4477 Fax: 844-233-7299 Web: www.bitco.com Follow ill Print this page Best's Credit Ratings Financial Strength Rating View Definition Rating: A+ (Superior) Affiliation Code: g (Group) Financial Size Category: XV($2 Billion or greater) Outlook: Stable Action: Affirmed Effective Date: May 17, 2019 Initial Rating Date: June 30, 1922 Long-Term Issuer Credit Rating View Definition Long-Term: aa- Outlook: Stable Action: Affirmed Effective Date: May 17, 2019 Initial Rating Date: June 20, 2005 http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002075&PPP= 6/24/2019 Page 2 of 7 u Denotes Under Review Best's Rating Licensing: Licensed Territory: (Current since 10/23/2001).The company is licensed in the District of Columbia, AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI and WY. http://consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=002075&PPP= 6/24/2019 Page 1 of 2 Consumer tools Agent and Company Lookup Orders Independent Review Decisions BITCO GENERAL INSURANCE CORPORATION Change History ( Licensing I Appointments I Complaints I Orders I National Info I Ratings I Tax Filings Back to Search General information Contact information Name: BITCO GENERAL INSURANCE CORPORATION Registered address Mailing address Corporate family group: OLD REPUBLIC GRP 0 307 N MICHIGAN AVE 3700 MARKET SQUARE CIR Organization type: PROPERTY CHICAGO, IL 60601 DAVENPORT, IA 52807- Doing Business As (DBA): Unavailable 2309 Telephone Telephone WAOIC: 200 800-621-0365 800-475-4477 NAIC: 20095 Status: ACTIVE Admitted date: 07/23/1963 Ownership type: STOCK T back to top Company change history o View changes back to top Types of coverage authorized to sell o Insurance types 'Casualty Marine Property Surety Vehicle `1'back to top Agents and agencies that represent this company (Appointments) o View agents View agencies '"back to top Company complaint history o View complaints • back to top Orders issued since 2010 o https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=200 6/24/2019 Page 2 of 2 View orders back to top Premium tax filings by tax year o 2018 2017 2016 2015 2014 a ack to top National information on insurance companies Want more information about this company? The NAIC's Consumer Information (CIS) page allows you to retrieve national financial and complaint information on insurance companies, plus has information and tips to help you understand current insurance issues. back to top Ratings by financial organizations The following organizations rate insurance companies on their financial strength and stability. Some of these companies charge for their services. A.M. Best Weiss Group Ratings Standard and Poor's Car. Moody's Investors Service Fitch IBCA, Duff and Phelps Ratings Disclaimer:Links to external or third-party websites are provided solely for visitors'convenience.Links you take to other sites are done so at your own risk and our office accepts no liability for any external linked sites or their content.Be aware that not all financial rating companies use the same rating processes. back to top https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=200 6/24/2019