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HomeMy WebLinkAboutCP1807 #19-04 Water Meter Vaults and Lids Replacement CITY OF AUBURN Nancy Backus, Mayor WASHINGTON 25 West Main Street * Auburn WA 98001-4998 * www.auburnwa.gov * 253-931-3000 February 19, 2020 CERTIFIED MAIL RETURN RECEIPT REQUESTED Clint Myers Northwest Cascade, Inc. PO Box 73399 Puyallup, WA 98373 NOTICE TO PROCEED RE: CP1807, Water Meter Vaults and Lids Replacement, Contract #19-04 You are hereby notified to proceed as of February 20, 2020 with the work on the above- referenced project, within the time period specified, in accordance with the provisions of the contract documents, copy enclosed. Your first working day will be February 21, 2020. This project has 60 working days for completion. If you have any questions, please contact the inspector for the project, Clint Willis at 253-804-5081 or the Contract Administration Specialist, Cindy West at 253-931-3002. Sincerely, Seth Wickstrom, P.E. Project Engineer Public Works Department SW/cw/as Enclosure cc: Shawn Campbell, City Clerk Jacob Sweeting, Assistant Director of Engineering/City Engineer Clint Willis, Project Inspector Amanda DeSilver, Contract Admin Supervisor File 13.11 CP1807 ENG-017, Revised 12/18 AUBURN ;k MORE THAN YOU IMAGINED CONTRACT Contract No. 19-04 THIS AGREEMENT AND CONTRACT, made and entered into, in duplicate, at Auburn, Washington, this 1q+* day of , 2020, by and between the CITY OF AUBURN, WASHINGTON, a municipal corporation, and NORTHWEST CASCADE, INC., PO Box 73399, Puyallup, WA 98373, hereinafter called the CONTRACTOR. WITNESSETH: That, in consideration of the terms and conditions contained in the Contract Documents entitled "CP1807, Water Meter Vaults and Lids Replacement," 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 CP1807, Water Meter Vaults and Lids Replacement—replacing eight large water meters and vaults and one large meter vault lid at multiple sites throughout the City for a unit bid price of seven hundred sixteen thousand two hundred twenty-one dollars ($716,221.00) and Washington State Sales Tax of seventy-one thousand six hundred twenty-two dollars and ten cents ($71,622.10) for a total contract value of seven hundred eighty-seven thousand eight hundred forty-three dollars and ten cents ($787,843.10) 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 7 calendar days after the receipt of the dated notification of award and the Contract time shall commence within 5 working days after execution of the Contract by the City and so designated on the Notice to Proceed. Physical completion shall be within 60 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 cy Backus, Mayor Countersigned: this , day of FdAuCtR 20o1NQ APPROVED AS TO FORM: Steve- ss, City Attorney IL_e,vuX144 Come ot.k-‘ NORTHWEST CASCADE, INC. 4 1 ! By _ 44Or Authorize. ;lfficial Signature Cil .► irs — P 6666157n� CONTRACT BOND CONTRACT NO. 19-04 BOND NO. 9331928 BOND TO CITY OF AUBURN, WASHINGTON KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, NORTHWEST CASCADE, INC., PO Box 73399, Puyallup, WA 98373, as principal, and Fidelity and Deposit Company of Maryland , a corporation, organized and existing under the laws of the State of Illinois 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 seven hundred eighty-seven thousand eight hundred forty-three dollars and ten cents ($787,843.10), 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. Dated at Auburn, Washington, this t jW' day of CY,brl,tatq , 20z20 Nevertheless, the conditions of the above obligation are such that: 1 WHEREAS, the City of Auburn on the 6th day of January, 2020, let to the above bounden principal a certain Contract. The said Contract being numbered 19-04, and providing for the construction of Project CP1807, Water Meter Vaults and Lids Replacement - replacing eight large water meters and vaults and one large meter vault lid at multiple sites throughout the City (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 r a 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 after the completion of this Contract and the expiration of the lien period, and if there are no liens pending, then the penal sum of this bond, shall be reduced to either ten percent (10%) of the value of the improvements to the City or two thousand dollars ($2,000), whichever is greater, to warranty against defects appearing or developing in the material or workmanship provided or performed under this Contract within a period of one (1) year after Contract Completion. Notwithstanding the reduction of this bond, the principal and surety shall hold the City of Auburn harmless from all defects appearing or developing in the material or workmanship provided or performed under this Contract within a period of one (1) year after Contract Completion, 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-bounden parties have executed this instrument this 21st day of January 20 20 . Ail/ ..A..mu lir w ,/-��— NORTHW :T CA CADE, INC. Fidelity and Deposit Company of Maryland By OA ,oy P ► sce, Carle spiritu • t in Fact Propel Insurance P.O. Box 2940, Tacoma, WA 98401-2940 (253) 759-2200 Resident Agent's Address& Phone Number i r" ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby nominate,constitute, and appoint Karen C. SWANSON, Erica E. MOSLEY, Holli ALBERS, Jamie L. MARQUES, Carley ESPIRITU, Christopher KINYON,Brent E. HEILESEN,Annelies M. RICHIE,Heather L. ALLEN and Kyle Joseph HOWAT,all of Tacoma, Washington, its true and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills,Maryland.,and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF,the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 20th day of November,A.D.2019. _Vic►'`—-• o w.,„, omit,* f: tanSEAL s �/ a 7 ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND By: Robert D.Murray Vice President Grtivytr tE By: Dawn E.Brown Secretary State of Maryland County of Baltimore On this 20th day of November, A.D.2019, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. ttdputl'�rr ar ate` ) \•i.�. .Z :i;2 Constance A.Dunn,Notary Public My Commission Expires:July 9,2023 +rrggnrto 1 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact, The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations,undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Secretary of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of the By- Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President,Secretary,or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. Ipia4TIMON WHF�RF�OF,I h ve j eygt2 cribed my name and affixed the corporate seals of the said Companies, this ``lei da of ((,, �a ���� �a�!,: , u otrpy. t�; `''t 0 =i o EAL 7 o ...•. By: Brian M.Hodges Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 www.reportsfclaimsAzurichna.com 800-626-4577 1/23/2020 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=442 Consumer.. tools Agent and Company Lookup Orders Independent Review Decisions FIDELITY & DEPOSIT COMPANY OF MARYLAND 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: FIDELITY & DEPOSIT COMPANY OF MARYLAND Registered address Mailing address Corporate family group: ZURICH INS GRP 0 1299 ZURICH WAY 1299 ZURICH WAY .. ......................................................... Organization type: PROPERTY SCHAUMBURG, IL 60196 SCHAUMBURG, IL 60196 Doing Business As (DBA): Unavailable Telephone Telephone WAOIC: 442 847-605-6000 847-605-3348 NAIC: 39306 Status: ACTIVE Admitted date: 07/27/1895 Ownership type: STOCK is back totop, Company change history o View changes back to top Types of coverage authorized to sell o Insurance types Casualty 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 View complaints w. ur ,. i + u,.eir r o. ai onrnnir—nn� 1/7 1/23/2020 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=000387&PPP= 132 Shares Fidelity and Deposit Company of Maryland (a member of Zurich Insurance US PC Group) AM Best#: 000387 NAIC#: 39306 FEIN#: 13-3046577 Address: 1299 Zurich Way Schaumburg, IL 60196-1056 UNITED STATES Phone: 847-605-6000 Fax: 877-962-2567 Web: www.zurichna.com Follow IN 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: September 25, 2019 Initial Rating Date: June 30, 1922 Long-Term Issuer Credit Rating View Definition Long-Term: aa- Outlook: Stable Action: Affirmed Effective Date: September 25, 2019 Initial Rating Date: September 14, 2004 u Denotes Under Review Best's Rating Licensing: (Current since 01/16/2009). The company is licensed in the District of Columbia, Guam, Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands and all states. rnnc,!more nmhoet rnm/rmmnm n,Prnfilo xnv9PI-'2RRomhni im=nhllQR7R PPP= I IQ BOND IN LIEU OF RETAINAGE (Retainage Bond -RCW 60.28) Bond No. 9331929 KNOW ALL PERSONS BY THESE PRESENTS, THAT NORTHWEST CASCADE, INC., PO Box 73399, Puyallup, WA 98373, a corporation organized under the laws of the State of Washington and registered to do business in the State of Washington as a contractor, as Principal, and Fidelity and Deposit Company of Maryland a corporation organized under the laws of the State of Illinois and registered to transact business in the State of Washington as surety, as Surety, their heirs, executors, administrators, successors and assigns, are jointly and severally held and bound to the City of Auburn, Washington, hereinafter called CITY, and are similarly held and bound unto the beneficiaries of the trust fund created by RCW 60.28, in the sum of five percent (5%) of all amounts earned by the Principal on the contract described below. THE CONDITIONS OF THIS BOND OBLIGATION ARE THAT: WHEREAS, on the VVt ay of F � , 2020, the Principal executed Contract No. 19-04 with the CITY for Project Number CP1807, Water Meter Vaults and Lids Replacement; and WHEREAS, said contract and RCW 60.28 require the CITY to withhold from the Principal the sum of five percent (5%) from monies earned by the Principal on estimates during the progress of the construction, hereinafter referred to as earned retained funds; and WHEREAS, the Principal has requested that the CITY not retain any earned retained funds as allowed under RCW 60.28; NOW, THEREFORE, the condition of this obligation is such that the surety is held and bound to the CITY and to the beneficiaries of the trust fund created by RCW 60.28 in the sum of five percent (5%) of the final contract cost which shall include any increases due to change orders, increases in quantities of work, addition of new items of work, or otherwise, hereafter referred to as the final contract cost. If all purposes of RCW 60.28 and all contract obligations are fulfilled, then this obligation shall be null and void; otherwise, it shall remain in full force and effect until release is authorized in writing by the CITY. IT IS FURTHER EXPRESSLY AGREED THAT: 1. The liability of the Surety under this bond shall not exceed five percent (5%) of the final contract cost, if no monies are retained by the CITY pursuant to RCW 60.28 on estimates during the progress of construction. Retainage Bond Page 1 of 3 ENG-050, Revised 9/18 2. In the event this bond ceases to comply with CITY standards, the CITY reserves the right to resume the actual withholding of earned retained funds according to the contractor's designated option for management of retainage under RCW 60.28.011(4). In the event the CITY resumes withholding of earned retained funds, the liability of the Surety under this bond shall not exceed the actual amount of the earned retained funds which were covered by this bond and released by the CITY prior to resumption of actual withholding. 3. The Surety hereby consents to and waives notice of any extension in the time for performance of the contract, assignment of obligations under the contract, or contract alteration, amendment, or change order. 4. Any suit under this bond must be instituted within the time period provided by applicable law with venue in King County, Washington. This bond and any proceeds therefrom shall be subject to all claims and liens and in the same manner and priority as set forth for retained percentages in RCW 60.28. 5. Until written release of this obligation by the CITY, this bond may not be terminated or canceled by the Principal or the Surety for any reason. Any extension of time for the Principal's performance on the contract, assignments of obligations under the contract, or any amendment to the contract or change orders of any kind shall not release the Surety from its obligation under this bond. 6. The contractor shall comply with all applicable requirements of RCW 60.28. 7. RCW 60.28 requires the CITY to accept a retainage bond in lieu of withholding earned retained funds and the Surety hereby waives any defense that this bond or bond form is void or otherwise not authorized by law. 8. Any claim or suit against the CITY to foreclose the liens provided for by RCW 60.28 shall be effective against the Principal and Surety and any judgment under 60.28 against the CITY shall be conclusive against the Principal and Surety. WITNESS our hands this 21st day of January 2020 PRINCIPAL: NORTHWEST CASCADE, INC. PO Box 73399 Puyallutor,A •81 8173 -.bmii Fawn By: •IP 4,,,,,_,; Signa ure of Auth,,zed Representative) A. !Mt. / s Print/Type Name Retainage Bond Page 2 of 3 ENG-050, Revised 9/18 SURETY: Fidelity and Deposit Company of Maryland By: 4NINI10111/ irt (Signa re o o ney — t .r Surety*) Carley Espiritu (Typed Name of Attorney-in-Fact) Dated 01/21/2020 Local Agent Name, Phone, & Address Propel Insurance P.O. Box 2940, Tacoma, WA 98401-2940 (253) 759-2200 CITY OF AUBURN: Accepted By: Jaco eting, sistant Diector of Engineering/City Engineer Dated: o2 �1 G 1./.0I Approved as to form: teve GrCity Attorney *This bond must be accompanied by a fully executed Power of Attorney appointing the Attorney-in-Fact before it becomes effective. Retainage Bond Page 3 of 3 ENG-050, Revised 9/18 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby nominate,constitute, and appoint Karen C. SWANSON, Erica E. MOSLEY, Holli ALBERS, Jamie L. MARQUES, Carley ESPIRITU, Christopher KINYON,Brent E. HEILESEN,Annelies M. RICHIE,Heather L.ALLEN and Kyle Joseph HOWAT,all of Tacoma, Washington, its true and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills,Maryland.,and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF,the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 20th day of November,A.D.2019. it. it tog SEAL fr fila _ tt» •` , * a Aft ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND By: Robert D.Murray Vice President By: Dawn E.Brown Secretary State of Maryland County of Baltimore On this 20th day of November, A.D.2019, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. C,dwp� , t�yty:,y► � �—Q. :4 1( / `,qvi ;��.,, ��r�•`$ Constance A.Dunn,Notary Public My Commission Expires:July 9,2023 '''amara` EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact, The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations,undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Secretary of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of the By- Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President,Secretary,or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. TIMONfi�t'NHEIOF,[h e reunt subscribed my name and affixed the corporate seals of the said Companies, this iday o � urs `�w`a`6 v o['os to S By: Brian M.Hodges Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 www.reportsfclaimsca,zurichna.com 800-626-4577 1/23/2020 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProfile.aspx?WAOIC=442 Consumer tools Agent and Company Lookup Orders Independent Review Decisions FIDELITY & DEPOSIT COMPANY OF MARYLAND 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: FIDELITY & DEPOSIT COMPANY OF MARYLAND Registered address Mailing address Corporate family group: ZURICH INS GRP 0 1299 ZURICH WAY 1299 ZURICH WAY Organization type: PROPERTY SCHAUMBURG, IL 60196 SCHAUMBURG, IL 60196 Doing Business As (DBA): Unavailable Telephone Telephone WAOIC: 442 847-605-6000 847-605-3348 NAIC: 39306 Status: ACTIVE Admitted date: 07/27/1895 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 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 View complaints 1/23/2020 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=000387&PPP= 132 Shares Fidelity and Deposit Company of Maryland (a member of Zurich Insurance US PC Group) AM Best#: 000387 NAIC#: 39306 FEIN#: 13-3046577 Address: 1299 Zurich Way Schaumburg, IL 60196-1056 UNITED STATES Phone: 847-605-6000 Fax: 877-962-2567 Web: www.zurichna.com Follow IN 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: September 25, 2019 Initial Rating Date: June 30, 1922 Long-Term Issuer Credit Rating View Definition Long-Term: aa- Outlook: Stable Action: Affirmed Effective Date: September 25, 2019 Initial Rating Date: September 14, 2004 u Denotes Under Review Best's Rating Licensing: (Current since 01/16/2009). The company is licensed in the District of Columbia, Guam, Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands and all states. Client#: 12831 NORTCASCI ACORDr0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/22/2020 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(les)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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Casondra Mossuto Propel Insurance PHONEFAX Tacoma Commercial Insurance (AMA No,Ext):800 499-0933 (NC,No): 866 577-1326 Rinks, Casondra.mossuto©propelinsurance.com 1201 Pacific Ave,Suite 1000 INSURER(S)AFFORDING COVERAGE NAIC# Tacoma,WA 98402 INSURERA:Zurich American Insurance Company 16535 INSURED INSURER B:Navigators Excess Casualty Division 42307 Northwest Cascade Inc.dba FloHawks INSURER C:Axis Surplus Insurance Company 26620 Honey Buckets&North Bay Portables INSURER D: PO Box 73399 INSURER E: Puyallup,WA 98373 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL'SUBR POLICY EFF POLICY EXP ' LTRINSR IWVD POLICY NUMBER (MM/DD/YYYYUMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GLA013642405 10/01/2019 10/01/2020 EACH OCCURRENCE $1,000,000 '" Ep CLAIMS-MADE X OCCUR PREMISESO(Ea occur ence) $300,000 X BI/PD Ded:$5,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I X JECOT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY GLA013642405 10/01/2019 10/01/2020 COMcdNEDSINGLE LIMIT 1,000,000 X ANY AUTO ODILYdINJURY(Per person) 1 OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident) $ B UMBRELLA LIABX OCCUR SEI9EXCZO346EQN 10/01/2019 10/01/2020 EACH OCCURRENCE $5,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION WC013642505 10/01/2019 10/01/2020 X (STATUTE ERH AND EMPLOYERS'LIABILITY ANYY IPROPRIETOER/PARTNERE ECUTIVEY/N N/A Incl. USL&H E.L.EACH ACCIDENT $1,000,000- (Mandatory In NH) &WA Stop Gap E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution CP002899032019 10/01/2019 10/01/2020 $1,000,000 Occ/Agg Liability $25,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RE:Contract NO. 19-04-Water Meter Vaults and Lids Replacement. CERTIFICATE HOLDER CANCELLATION City of Auburn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 25 West Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Auburn,WA 98001 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3985478/M3927275 JNLOO This page has been left blank intentionally. • Additional Insured — Automatic — Owners, Lessees Or ZURICH Contractors Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem. GLA-0136424-05 10/01/2019 10/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II —Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U-GL-1175-F CW(04/13) Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence"or offense that may result in a claim; 2. We receive written notice of a claim or"suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV—Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or"suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III—Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. U-GL-1175-F CW(04/13) Page 2 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 92 Waiver Of Subrogation (Blanket) Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer Add'l.Prem Return Prern. GLA-0136424-05 10/01/2019 10/01/2010 $ $ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: If you are required by a written contract or agreement,which is executed before a loss,to waive your rights of recovery from oth- ers,we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest. U-GL-925-B CW(12/01) Page 1 of 1 POLICY NUMBER: GLA-0136424-05 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): ANY CONSTRUCTION PROJECT EXCEPT A CONSTRUCTION PROJECT FOR WHICH A CONSOLIDATED(WRAP-UP)OR SIMILAR INSURANCE PROGRAM HAS BEEN PROVIDED. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by "occur- damages or under Coverage C for medical rences" under Section I —Coverage A, and for all expenses shall reduce the Designated Con- medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- 1. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products cable Designated Construction Project Gen- completed operations hazard", and for medi- cal eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 2 Wolters Kluwer Financial Services I Uniform FormsTM B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products-completed operations hazard" is pro- rences" under Section I —Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be at- the "products-completed operations hazard" will tributed only to ongoing operations at a single reduce the Products-completed Operations Ag- designated construction project shown in the gregate Limit, and not reduce the General Ag- Schedule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract- Products-completed Operations Aggregate ing parties deviate from plans, blueprints, de- Limit, whichever is applicable; and signs, specifications or timetables, the project will 2. Such payments shall not reduce any Desig still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. gate Limit. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 • Contractors Liability Supplemental Coverages And ZURICH Conditions Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I.Prem Return Prem. GLA-0136424-05 10/01/2019 10/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part NON-OWNED WATERCRAFT SCHEDULE Watercraft Length: feet (If no amount is shown above, 51 feet applies.) A. Non-owned Watercraft Liability Extended Coverage Paragraph (2) of Exclusion 2.g. Aircraft, Auto Or Watercraft under Section I—Coverage A— Bodily Injury And Property Damage Liability is replaced by the following: (2) A watercraft you do not own that is: (a) Less than the length shown in the Non-Owned Watercraft Schedule of this endorsement; and (b) Not being used to carry persons or property for a charge; B. Damage To Premises Rented Or Occupied By You 1. The last paragraph under Paragraph 2. Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by"specific perils"to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Damage to Premises Rented To You Limit of Insurance applies to this coverage as described in Section III—Limits Of Insurance. 2. The paragraph directly following Paragraph (6) in Exclusion j. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to premises (other than damage by "specific perils"), including "property damage" to the contents of such premises, rented to you under a rental agreement for a period of 14 or fewer consecutive days. A separate Limit of Insurance applies to Damage to Premises Rented to You as described in Section III—Limits Of Insurance. 3. Paragraph 6. of Section III—Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or in the case of damage by one or more "specific perils" to any one premises, while rented to you or temporarily occupied by you with permission of the owner. 4. Paragraph a. of the "insured contract"definition under the Definitions Section is replaced by the following: U-GL-1060-E CW(04/13) Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 5. Paragraph (ii) under Paragraph 4.b.(1) of the Other Insurance Condition under Section IV — Commercial General Liability Conditions is replaced by the following: (ii) That is property insurance providing coverage for "specific perils" for premises rented to you or temporarily occupied by you with permission of the owner; 6. The following definitions are added to the Definitions Section: "Specific perils" means fire, lightning, explosion, windstorm or hail, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment, weight of snow, ice or sleet or"water damage". 'Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking or cracking of any part of a system or appliance containing water or steam. C. Additional Insured —Lessor Of Leased Equipment—Automatic Status When Required In Lease Agreement With You 1. Section II —Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in a written contract or written agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s)or organization(s). However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. 2. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any "occurrence"which takes place after the equipment lease expires. 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance provided by this Paragraph C. shall not increase the applicable Limits of Insurance shown in the Declarations. D. Additional Insured—Managers Or Lessors Of Premises 1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) that you have agreed in a written contract or written agreement to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of premises leased to you and subject to the following additional exclusions: This insurance does not apply to: a. Any"occurrence"which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured manager or lessor of the premises leased to you. However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and U-GL-1060-E CW(04/13) Page 2 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance provided by this Paragraph D. shall not increase the applicable Limits of Insurance shown in the Declarations. E. Additional Insured—State Or Governmental Agency Or subdivision Or Political Subdivision— Permits Or Authorizations 1. Section II—Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision that you have agreed in a written contract or written agreement or that you are required by statute, ordinance or regulation to name as an additional insured, subject to the following provisions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. b. This insurance does not apply to: (1) "Bodily injury", "property damage"or"personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or (2) "Bodily injury" or"property damage included within the "products-completed operations hazard". However, the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance provided by this Paragraph E. shall not increase the applicable Limits of Insurance shown in the Declarations. F. Personal And Advertising Injury Coverage—Assumed Under Contract Or Agreement 1. Exclusion e. of Section I—Coverage B—Personal And Advertising Injury Liability is replaced by the following: 2. Exclusions This insurance does not apply to: e. Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for"personal and advertising injury" if: U-GL-1060-E CW(04/13) Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. (a) The liability pertains to your business and is assumed in a contract or agreement that is an "insured contract"; and (b) The "personal and advertising injury" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability so assumed in such "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of"personal and advertising injury", provided: (i) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same contract or agreement; and (ii) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 2. For purposes of this "personal and advertising injury"coverage only: Paragraph d. and the second to last paragraph under Paragraph 2. of Supplementary Payments — Coverages A and B are replaced by the following: d. The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no conflict appears to exist between the interests of the insured and the interest of the indemnitee; So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Such payments will not be deemed to be damages for "bodily injury", "property damage" or "personal and advertising injury" and will not reduce the limits of insurance. G. Insured Contract Amendment Paragraph f. and f.(1) through f.(3) of the "insured contract" definition under the Definitions Section is replaced by the following: f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for "bodily injury", "property damage" or "personal and advertising injury" arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities; (4) That indemnifies a person or organization for"personal and advertising injury": (a) Arising out of advertising, publishing, broadcasting or telecasting done for you or on your behalf; or (b) To an "employee" of such person or organization that does advertising, publishing, broadcasting or telecasting for you or on your behalf; or (5) That indemnifies a labor leasing firm for"bodily injury"to "leased workers". U-GL-1060-E CW(04/13) Page 4 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. H. Medical Payments—Increased Reporting Period Paragraph a. of Section I—Coverage C—Medical Payments is replaced by the following: a. We will pay medical expenses as described below for"bodily injury"caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; or (3) Because of your operations; provided that: (a) The accident takes place in the "coverage territory"and during the policy period; (b) The expenses are incurred and reported to us within three years of the date of the accident; and (c) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. I. Broad Bail Bond Coverage Paragraph 1.b. under Supplementary Payments—Coverages A And B is replaced by the following: b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. J. Amendment—Duties In The Event of Occurrence, Offense, Claim or Suit The following paragraphs are added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV—Commercial General Liability Conditions: Notice of an "occurrence" or of an offense which may result in a claim under this insurance or notice of a claim or "suit" shall be given to us as soon as practicable after knowledge of the "occurrence", offense, claim or "suit" has been reported to your officer, manager, partner or an "employee" authorized by you to give or receive such notice. Knowledge by "employees" other than your officer, manager, partner or "employee" authorized by you to give or receive such notice of an "occurrence", offense, claim or"suit"does not imply that you also have such knowledge. In the event that an insured reports an "occurrence" to your workers compensation carrier and this "occurrence" later develops into a General Liability claim, covered by this Coverage Part, the insured's failure to report such "occurrence" to us at the time of the "occurrence" shall not be deemed to be a violation of this Condition. You must, however, give us notice as soon as practicable after being made aware that the particular claim is a General Liability rather than a Workers Compensation claim. K. Unintentional Failure To Disclose Or Describe Hazards Paragraph 6. Representations of Section IV — Commercial General Liability Conditions is replaced by the following: 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. Coverage will continue to apply if you unintentionally: (1) Fail to disclose all hazards existing at the inception of this policy; or (2) Make an error, omission or improper description of premises or other statement of information stated in this policy. You must notify us in writing as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to inception of this Coverage Part. L. Bodily Injury Redefined The"bodily injury" definition under the Definitions Section is replaced by the following: U-GL-1060-E CW(04/13) Page 5 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish, mental injury, shock, fright or death resulting from bodily injury, sickness or disease. M. Two Or More Of Our Coverage Parts/Policies The following is added to Section III — Limits of Insurance: 1. Subject to Paragraph 2. or 3. above, whichever applies, if this Coverage Part and any other Commercial General Liability Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply to the same "occurrence", only the highest available Each Occurrence Limit under any such Coverage Part or policy applies to such "occurrence". 2. Subject to Paragraph 2. above, if this Coverage Part and any other Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply to the same offense, only the highest available Personal And Advertising Injury Limit under any such Coverage Part or policy applies to such offense. 3. Under this Coverage Part and all other Zurich underwriting company Coverage Parts or policies to which Paragraphs 1. and 2. above combined apply, the most we will pay for all injury or damage because of "bodily injury"or"property damage""occurrences", "personal and advertising injury"offenses and medical expenses is: a. The single highest Coverage Part or policy General Aggregate Limit; or b. The single highest Coverage Part or policy Products-Completed Operations Aggregate Limit, whichever applies, whether such "occurrence", offenses or medical expenses are covered by one or more than one Zurich underwriting company policy. 4. Any existing provisions under Paragraph 4. Other Insurance under Section IV — Commercial General Liability Conditions that may be contrary to the provisions of this endorsement are amended to comply with the changes in coverage as stipulated in Paragraphs 1., 2., and 3. above. This provision does not apply to any Coverage Part or policy issued by us or any other Zurich underwriting company affiliated with us specifically to apply as excess insurance over this Coverage Part. N. Your Work Redefined Paragraph a.(1)of the "your work"definition under the Definitions Section is replaced by the following: 22. "Your work": a. Means: (1) Work or operations performed by you or on your behalf, but does not include work or operations performed by another entity who joined with you to form a partnership or joint venture not shown as a Named Insured in the Declarations, which terminated or ended prior to the effective date of this policy; and All other terms and conditions of this policy remain unchanged. U-GL-1060-E CW(04/13) Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Coverage Extension Endorsement ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I.Prem Return Prem. GLA-0136424-05 10/01/2019 10/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who Is An Insured 1. The following is added to the Who Is An Insured Provision in Section II—Covered Autos Liability Coverage: The following are also"insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any "employee" of yours is also 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. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s)where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. 2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance—Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any"accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured"will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment—Supplementary Payments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II — Covered Autos Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. U-CA-424-F CW(04/14) Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. • C. Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II—Covered Autos Liability Coverage does not apply. D. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II—Covered Autos Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. 2. The following is added to Paragraph 2. in the Exclusions of Section Ill — Physical Damage Coverage of the Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss"to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and b. Any: (1) Overdue lease or loan payments at the time of the"loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous leases or loans. F. Towing and Labor Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the labor must be performed at the place of disablement. G. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. H. Hired Auto Physical Damage—Increased Loss of Use Expenses The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the following: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: U-CA-424-F CW(04/14) Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; (2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of$3000. I. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a. We will pay up to $750 for"loss"to personal effects which are: (1) Personal property owned by an "insured"; and (2) In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for"loss"to personal effects will be based on the lesser of: (1) The reasonable cost to replace; or (2) The actual cash value. c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other documents of value. (2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, precious or semi-precious stones. (3) Paintings, statuary and other works of art. (4) Contraband or property in the course of illegal transportation or trade. (5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. Any coverage provided by this Provision is excess over any other insurance coverage available for the same"loss". J. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of"loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical Damage Coverage Deductible Provision does not apply to such "loss". U-CA-424-F CW(04/14) Page 3 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • K. Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III—Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage Form does not apply to the accidental discharge of an airbag. L. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you by us,the following applies for each covered "auto" on a per vehicle basis: 1. If the deductible on this policy or Coverage Form is the smaller(or smallest) deductible, it will be waived; or 2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller(or smallest)deductible. M. Physical Damage—Comprehensive Coverage—Deductible The following is added to the Deductible Provision of the Physical Damage Coverage Section: Regardless of the number of covered "autos"damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss"from any one cause is $5,000 or the deductible shown in the Declarations, whichever is greater. N. Temporary Substitute Autos— Physical Damage 1. The following is added to Section I—Covered Autos: Temporary Substitute Autos— Physical Damage If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following types of vehicles are also covered "autos"for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered "auto" you do own but is out of service because of its: 1. Breakdown; 2. Repair; 3. Servicing; 4. "Loss"; or 5. Destruction. 2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section: Temporary Substitute Autos— Physical Damage We will pay the owner for"loss"to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other party. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it replaces. O. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of"accident", claim, "suit" or"loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any U-CA-424-F CW(04/14) Page 4 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. agent, servant or employee of the "insured"to notify us of any"accident", claim, "suit"or"loss"shall not invalidate the insurance afforded by this policy. Include, as soon as practicable: (1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written notice of the claim or"suit" including, but not limited to, the date and details of such claim or"suit"; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. P. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident" or"loss" arises out of operations contemplated by such contract. This waiver only applies to the person or organization designated in the contract. Q. Employee Hired Autos— Physical Damage Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph 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 under a written contract or written agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official's duties as respect their obligations to you. However, any"auto"that is leased, hired, rented or borrowed with a driver is not a covered "auto". R. Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this Coverage Form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2) Make an error, omission, improper description of"autos"or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. S. Hired Auto—World Wide Coverage Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following: (5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, T. Bodily Injury Redefined The definition of"bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. U-CA-424-F CW(04/14) Page 5 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. U. Expected Or Intended Injury The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II —Covered Auto Liability Coverage is replaced by the following: Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. V. Physical Damage—Additional Temporary Transportation Expense Coverage Paragraph A.4.a.of Section III— Physical Damage Coverage is replaced by the following: 4. Coverage Extensions a. Transportation Expenses We will pay up to $50 per day to a maximum of$1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes 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 expiration, when the covered "auto" is returned to use or we pay for its "loss". W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section: In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or "auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease agreement. To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas, either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source. X. Return of Stolen Automobile The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section: If a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay only for those covered "autos"for which you carry either Comprehensive or Specified Causes of Loss Coverage. All other terms, conditions, provisions and exclusions of this policy remain the same. U-CA-424-F CW(04/14) Page 6 of 6 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium$ Insurance Company Countersigned By WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance 1/23/2020 https://fortress.wa.gov/oic/consumertoolkiUCompany/CompanyProfile.aspx?WAOIC=1476 Agent and Company Lookup Orders Independent Review Decisions ZURICH AMERICAN INSURANCE COMPANY Change History I Licensing I Appointments Complaints I Orders I National Info I Ratings I Tax Filings Back to Search General information Contact information Name: ZURICH AMERICAN INSURANCE COMPANY Registered address Corporate family group: ZURICH INS GRP 0 FOUR WORLD TRADE Mailing address .... . ...................................... Organization type: PROPERTY CENTER 1299 ZURICH WAY Doing Business As (DBA): Unavailable 150 GREENWIDH ST SCHAUMBURG, IL 60196 NEW YORK, NY 10007 WAOIC: 1476 Telephone Telephone 847-605-6000 NAIC: 16535 012-225-7000 Status: ACTIVE Admitted date: 06/25/1923 Ownership type: STOCK back to top Company change history a View changes back to top ........................... Types of coverage authorized to sell a Insurance types Casualty Disability Marine Ocean Marine Property Surety Vehicle ?back to top ............................. Agents and agencies that represent this company (Appointments) a View agents . View agencies back to top ................. Company complaint history a 1/23/2020 consumers.ambest.com/CompanyProfile.aspx?BL=36&URATINGID=2779216&MCToken=1304819416975162199178200445352121952... 132 Shares Zurich American Insurance Company (a member of Zurich Insurance US PC Group) AM Best#: 002563 NAIC#: 16535 FEIN#: 36-4233459 Address: 1299 Zurich Way Schaumburg, IL 60196-1056 UNITED STATES Phone: 800-987-3373 Fax: 877-962-2567 Web: www.zurichna.com Follow F_■! 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: September 25, 2019 Initial Rating Date: June 30, 1922 Long-Term Issuer Credit Rating View Definition Long-Term: aa- Outlook: Stable Action: Affirmed Effective Date: September 25, 2019 Initial Rating Date: September 14, 2004 u Denotes Under Review Best's Rating Licensing: (Current since 01/22/2009). The company is licensed in the District of Columbia, Guam, Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands and all states. 1/23/2020 https://fortress.wa.gov/oic/consumertoolkit/Company/CompanyProf le.aspx?WAOIC=84998 0 {1 s u f n ertool Agent and Company Lookup Orders Independent Review Decisions NAVIGATORS 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: NAVIGATORS INSURANCE COMPANY Registered address Mailing address Corporate family group: HARTFORD FIRE & CAS 1375 E WOODFIELD RD ONE PENN PLAZA 32ND FL GRP 0 SUITE 720 Organization type: PROPERTY NEW YORK, NY 10119 SCHAUMBURG, IL 60173 Doing Business As (DBA): Unavailable Telephone 914-934-8999 Telephone WAOIC: 84998 847-230-1930 NAIC: 42307 Status: ACTIVE Admitted date: 08/22/1991 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 1/23/2020 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=001825&PPP= 132 Shares Navigators Insurance Company (a member of Hartford Insurance Group) AM Best#: 001825 NAIC#:42307 FEIN#: 13-3138390 Address: 400 Atlantic Street 8th Floor Stamford, CT 06901 UNITED STATES Phone: 203-905-6090 Fax: 203-658-1821 Web: www.navg.com Follow 141 Print this page Best's Credit Ratings Financial Strength Rating View Definition Rating: A+ (Superior) Financial Size Category: XI ($750 Million to $1 Billion) Outlook: Stable Action: Upgraded Effective Date: August 30, 2019 Initial Rating Date: June 30, 1988 Long-Term Issuer Credit Rating View Definition Long-Term: aa- Outlook: Stable Action: Upgraded Effective Date: August 30, 2019 Initial Rating Date: October 10, 2005 u Denotes Under Review Best's Rating Licensing: (Current since 11/06/2018). The company is licensed in the District of Columbia, Guam, Puerto Rico, U.S. Virgin Islands and all states. This company is also licensed in the United Kingdom. 1123/2020 Carriers I Surplus Lines Association of Washington , SEARCH Carriers Home > Carriers Carrier Requirements Carriers List of A Ca,rier$ Inclusion on this list does not indicate that the carrier meets the requirement as an appropriate insurer.The Surplus Line Broker is solely responsible for determining the qualifications of each carrier.Being on this list means the carrier is recognized by the Surplus Line Association of Washington and filings by brokers for the carrier will be accepted for examination. Search By Insurer Name or City: Axis Surplus Insurance Search Insurer Name Address City S... AXIS SURPLUS INSURANCE COMPANY 111 SOUTH WACKER DRIVE CHICAGO IL 1-lot litems Copyright©2020 Surplus Line Association of Washington,All Rights Reserved. 1/3/2020 consumers.ambest.com/CompanyProfile.aspx?BL=36&ambnum=012515&PPP= 132 Shares AXIS Surplus Insurance Company (a member of AXIS US Operations) AM Best#: 012515 NAIC#: 26620 FEIN#: 63-0941128 Address: 11680 Great Oaks Way Suite 500 Alpharetta, GA 30022 UNITED STATES Phone: 678-746-9400 Fax: 678-746-3420 Web: www.axiscapital.com Follow IN 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: Negative Action: Affirmed Effective Date: March 15, 2019 Initial Rating Date: June 20, 2002 Long-Term Issuer Credit Rating View Definition Long-Term: aa- Outlook: Negative Action: Affirmed Effective Date: March 15, 2019 Initial Rating Date: May 16, 2005 u Denotes Under Review Best's Rating CITY OF AUBURN PUBLIC WORKS DEPARTMENT ADDENDUM NO. 1 DATE: December 10, 2019 Project Number CP1807, Contract No. 19-04 Water Meter Vaults and Lids Replacement Bid Opening Date: December 17, 2019 11:00 AM PT The following revisions, additions, and/or deletions are hereby made a part of the specifications and plans of the above-named contract and shall be taken into consideration by the bidder in submitting their bid: BID PROPOSAL PACKAGE: 1. REPLACE the entire Original Bid Proposal Package with the attached Revised Bid Proposal Package. The following is a summary of changes to the Original Bid Proposal Package: a. New Bid Item "Connect to Existing Water Main" created. b. Quantities for Bid Item Nos. 30 (Tapping Sleeve and Valve Assembly 6 x 4 In.), 31 (Tapping Sleeve and Valve Assembly 12 x 4 In.) and 32 (Tapping Sleeve and Valve Assembly 20 x 4 In.) have been revised. c. The Unit Price and Total Price values that were shown for Bid Item 37 (Replace Water Meter Vault Lid) have been removed. d. Unit Price and Total Price values have been added to Bid Item 38 (Erosion/Water Pollution Control). e. Quantities and Units for Bid Item Nos. 43 (Cement Conc. Traffic Curb and Gutter) through 52 (Temporary Pavement Marking — Short Duration) have been updated. CONTRACT PLANS: 1. CLARIFICATION: The existing water main being tapped into shown on Plan Sheet No. 11 is 12-inches in diameter as stated in Construction Note No. 6; not 20-inches in diameter as stated in the Plan view. By signing the space provided in the "Receipt of Addenda" section of the "Bid Proposal", bidders certify and acknowledge receipt of Addendum No. 1 and to due consideration thereof in preparing and submitting the "Bid Proposal". Failure to acknowledge receipt of this Addendum on the "Bid Proposal" may be considered an irregularity in the "Bid Proposal". Prepared By: '1 �— ►t�Io/19 Project Manager Date Approved By: Jacobweeti" g, P.E./ ate City Engineer/Asst. Director of Engineering Services CITY OF AUBURN WASHINGTON 2018 WSDOT CITY OF AUBURN KING AND PIERCE COUNTIES , WASHINGTON BID PROPOSAL PACKAGE for Project Number CP1807 WATER METER VAULTS AND LIDS REPLACEMENT Contract No. 19-04 Bid Opening Date: December 17, 2019 11:00 AM PT City of Auburn Engineering Division Public Works Department 25 West Main St. Auburn, WA 98001-4998 (253) 931-3010 Addendum No. 1 BIDDER'S CHECKLIST Bidder must execute and return with submittal: 1. PROPOSAL FORM The unit prices bid must be shown in the space provided. The proposal shall be filled in and signed by the bidder. 2. CONTRACTOR CERTIFICATION WAGE LAW COMPLIANCE 3. RESPONSIBLE BIDDER INFORMATION To show contractor's ability to perform jobs of a similar nature. 4. PROPOSED EQUIPMENT AND MANPOWER SCHEDULE Provide a complete list of equipment and manpower to be used on project. 5. LOCAL AGENCY SUBCONTRACTOR LIST List all subcontractors who are proposed to perform the work of heating, ventilation and air conditioning, plumbing, and electrical. Failure to submit this with the bid shall render the bid nonresponsive. (Form 271-015 included for this purpose). See Section 1-02.6 (Preparation of Proposal). 6. BID BOND This form is to be executed by the bidder and the Surety Company unless cash, cashier's check or a certified check in the amount of 5% of the total bid accompanies bid. The amount of this bond shall be not less than five percent (5%) of the total amount bid and may be shown in dollars or on a percentage basis. After the Contract is awarded, execute: 1. CONTRACT To be executed by the successful bidder in duplicate. 2. CONTRACT BOND To be executed by the successful bidder and his surety company in duplicate. 3. POWER OF ATTORNEY To be submitted in duplicate. 4. EVIDENCE OF INSURANCE To be submitted in duplicate. 5. PRELIMINARY CONSTRUCTION PROGRESS SCHEDULE Submitted in duplicate, showing the first 30 working days, to the Engineer 1 working day prior to the date of the Pre-construction Conference. To be provided in conformance with Section 1-08.3 (Progress Schedule) of the Standard Specifications. 6. REQUEST TO SUBLET WORK One copy for each subcontractor and lower tier subcontractor shall be submitted and approved by the City, prior to the subcontractor entering the project work site(s) to perform work. (Sample form is included). PROPOSAL FORM Page of CITY OF AUBURN Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Bid Opening: December 17, 2019 Bids received after this time will be returned to sender unopened in accordance with Section 1-02.9 (Delivery of Proposal) of the Specifications. The undersigned hereby certifies that: 1. The project site has been inspected. 2. The Bid Documents governing the work have been read and are thoroughly understood. 3. The bidder is willing and able to execute the Contract, provide a Contract Bond and Evidence of Insurance within 7 calendar days following the receipt of the dated "Notice of Award". 4. The "Contractor Certification Wage Law Compliance", "Responsible Bidder Information" and "Proposed Equipment and Manpower Schedule" forms have been completed and are enclosed with this Bid Proposal. 5. A "Local Agency Subcontractor List" per Section 1-02.6 (Preparation of Proposal) of the specifications has been completed and is enclosed with this Bid Proposal, if applicable. 6. A 5% Bid Deposit has been enclosed with this Bid Proposal. 7. All addendums have been acknowledged in the space provided in this Bid Proposal. 8. The bidder will promptly undertake the work upon receipt of the dated "Notice to Proceed" that will be issued within 5 working days of the contract execution date and complete the work embraced in this improvement in accordance with the Contract Documents at the following schedule of rates and prices, and it is understood that failure to complete the work within the time stated in Section 1-08.5 (Time for Completion) of the Specifications will be cause for assessment of liquidated damages in accordance with Section 1-08.9 (Liquidated Damages) of the Specifications. 9. The City may choose to include additive and/or alternate bid items or bid schedules on the Proposal Form and, if included, the City has the right to select any or all of the additive and/or alternate bid items or bid schedules. The additive and/or alternate bid items or bid schedules selected shall be added to the basic bid and the Contract award will be made based on the lowest and most acceptable total bid including selected additives and/or alternates. 10. The method of payment will be made only on the unit prices for items appearing on this Bid Proposal form. 11. The bidders must bid all items in the bid proposal. If any items are left blank or represent $0.00, the bid may be disqualified. NOTE: Unit prices for all items, all extensions and the total amount of bid must be shown. All proposals shall be typed or written in ink. FIRM NAME PROPOSAL FORM Page2of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Schedule A: Water Improvements Bid orr Sec. Description Quantity Unit Unit Total Price Item SP No. Price 1 Std 1-04 Minor Changes 25000 EST $1.00 $25,000.00 2 SP 1-05 Record Drawings (Minimum Bid $500) 1 LS $ $ 3 Std 1-07 SPCC Plan 1 LS $ $ 4 SP 1-07 Utility Potholing 1 EA $ $ 5 Std 1-09 Mobilization 1 LS $ $ 6 SP 1-10 Traffic Control Supervisor 1 LS $ $ 7 SP 1-10 Traffic Control Labor(Min. Bid $43.11 per 1000 HR $ $ hour) 8 SP 1-10 Sequential Arrow Sign 40 DAY $ $ 9 SP 1-10 Portable Changeable Message Sign 20 DAY $ $ 10 Std 2-01 Clearing and Grubbing 1 LS $ $ 11 SP 2-02 Remove and Reset Fence 25 LF $ $ 12 Std 2-02 Removal of Structures and Obstructions 1 LS $ $ 13 SP 2-02 Removal of Asphalt Pavement 95 SY $ $ 14 SP 2-02 Removal of Concrete Pavement 165 SY $ $ 15 SP 2-02 Remove Cement Concrete Sidewalk 175 SY $ $ 16 SP 2-02 Remove Cement Concrete Curb and 120 LF $ $ Gutter 17 Std 4-04 Crushed Surfacing Top Course 50 TON $ $ 18 Std 4-04 Crushed Surfacing Base Course 95 TON $ $ 19 Std 5-04 HMA Cl. 1/2-inch PG 64-22 140 TON $ $ 20 Std 5-04 Planing Bituminous Pavement 365 SY $ $ 21 SP 5-05 Cement Concrete Pavement-Including 180 SY $ $ Dowels FIRM NAME PROPOSAL FORM Page3of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Schedule A: Water Improvements Bid Soo Sec. Description Quantity Unit Unit Total Price Item SP No. Price 22 SP 7-08 Pipe Foundation Material 30 TON $ $ 23 SP 7-08 Pipe Zone Bedding 125 TON $ $ 24 SP 7-08 Select Pipe Trench Backfill 215 TON $ $ 25 Std 7-08 Shoring or Extra Excavation Class B 1240 SF $ $ 26 Std 7-08 Plugging Existing Pipe 8 EA $ $ 27 SP 7-09 Special Class 52 Ductile Iron Pipe for 100 LF $ $ Water Main, 3 In. Diam. 28 SP 7-09 Special Class 52 Ductile Iron Pipe for 210 LF $ $ Water Main, 4 In. Diam. 29 SP 7-09 2-inch Blowoff Asssembly 1 EA $ $ 30 SP 7-09 Connect to Existing Water Main 8 EA $ $ 31 Std 7-12 Tapping Sleeve and Valve Assembly 6 2 EA $ $ x 4 In. 32 Std 7-12 Tapping Sleeve and Valve Assembly 12 1 EA $ $ x 4 In. 33 Std 7-12 Tapping Sleeve and Valve Assembly 20 2 EA $ $ x 4 In. 34 SP 7-12 Adjust Valve Box 5 EA $ $ 35 SP 7-14 Hydrant Assembly 1 EA $ $ 36 SP 7-20 3 inch Diam. Water Meter and Vault 6 EA $ $ 37 SP 7-20 4 inch Diam. Water Meter and Vault 2 EA $ $ 38 SP 7-20 Replace Water Meter Vault Lid 1 EA $ $ 39 Std 8-01 Erosion/Water Pollution Control 7500 EST $ 1.00 $7,500.00 40 Std 8-01 Inlet Protection 3 EA $ $ 41 SP 8-02 Topsoil Type A 20 CY $ $ 42 Std 8-02 Sod Installation 55 SY $ $ FIRM NAME Addendum No. 1 PROPOSAL FORM Page4of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Schedule A: Water Improvements Std Unit ltBelm Sr Sec. Description Quantity Unit Price Total Price 43 SP 8-02 Bark Mulch 2 CY $ $ 44 Std 8-04 Cement Conc. Traffic Curb and Gutter 120 LF $ $ 45 Std 8-09 Raised Pavement Marker Type 2 10 EA $ $ 46 Std 8-14 Cement Conc. Sidewalk 175 SY $ $ 47 SP 8-21 Remove Traffic Sign 2 EA $ $ 48 SP 8-21 Traffic Sign 2 EA $ $ 49 Std 8-22 Paint Line 250 LF $ $ 50 Std 8-22 Painted Wide Lane Line 40 LF $ $ 51 Std 8-22 Plastic Crosswalk Line 18 SF $ $ 52 Std 8-22 Plastic Traffic Arrow 4 EA $ $ 53 Std 8-23 Temporary Pavement Marking-Short 290 LF I $ $ Duration Subtotal Schedule A $ FIRM NAME Addendum No. 1 PROPOSAL FORM Page5of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Bid Summary: Subtotal Schedule A $ WA State Sales Tax Schedule A (10.0%) $ Total Gross Bid (Subtotal Schedule A + Sales Tax) $ If sales tax is shown for a schedule above sales tax should not be included in bid item prices for that schedule (Rule 170). If sales tax is not identified above Contractor shall include appropriate sales tax in each bid item price as applicable (Rule 171). RECEIPT OF ADDENDA. I certify and acknowledge receipt of the following Addenda to the Bid Documents and that due consideration thereof has been used in preparing and submitting this Bid Proposal. Addendum Date of Receipt Signed No. of Addendum Acknowledgment 1 2 3 4 (NOTE: Failure to herein acknowledge receipt of the addenda may be considered an irregularity in this proposal.) FIRM NAME PROPOSAL FORM Page6of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Submitted by: I certify under penalty of perjury under the laws of the State of Washington that I am the official authorized to submit this Bid Proposal on behalf of: FIRM NAME: Address: Phone #: Email: Authorized Official: Title: (Please print name) Date: (Signature) Authorized Official: Title: (Please print name) Date: (Signature) Place of Execution: City and State NOTE: 1. Bidder is a(n):[ ] Corporation [ ] Individual [ ] Partnership [ ] Joint Venture [ ] Other 2. If the bidder is a corporation, its duly authorized officials must execute this proposal. Incorporated in the State of State Contractor State Contractor License #: License Expiration Date: State Unified Business Employment Security Identifier (UBI) #: Department#: State Excise Tax Registration #: Federal Tax ID #: Construction Contractors: Please use the following City of Auburn Tax Code Numbers on retail sales where the labor and services are primarily performed in Auburn; 1. Number 1702 when the work is performed in King County 2. Number 2724 when the work is performed in Pierce County Submit Bid Proposal to: Office of City Clerk City of Auburn 25 West Main Street Auburn, WA. 98001-4998 CITY OF Au B . WASHINGTON Contractor Certification Wage Law Compliance - Responsibility Criteria Washington State Public Works Contracts FAILURE TO RETURN THIS CERTIFICATION AS PART OF THE BID PROPOSAL PACKAGE WILL MAKE THIS BID NONRESPONSIVE AND INELIGIBLE FOR AWARD I hereby certify, under penalty of perjury under the laws of the State of Washington, on behalf of the firm identified below that, to the best of my knowledge and belief, this firm has NOT been determined by a final and binding citation and notice of assessment issued by the Washington State Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the Call for Bids. Bidder Name: Name of Contractor/Bidder-Print full legal entity name of firm By: Signature of authorized person Print Name of person making certifications for firm Title: Place: Title of person signing certificate Print city and state where signed Date: WSDOT Form 272-009 08/2017 RESPONSIBLE BIDDER INFORMATION Bidder has been in business continuously from (year). Bank Reference: Bank Name Account Officer Phone No. Number of regular full-time employees: Number of projects in the past 5 years completed: ahead of schedule on schedule behind schedule Bidder has had experience in work comparable to that required for this Project: As a prime contractor for years. As a subcontractor for years. List the supervisory personnel to be employed by the Bidder and available for work on this project (Project manager, Foreman, Site Superintendent, Engineer, etc.): Name Title Years with firm List below, non-City of Auburn construction work successfully completed by the bidder within the past five years which was similar in size, scope, and difficulty to the work herein being bid upon. Year Contract Project Name Completed Amount Owner/Reference Name & Phone • • List all projects undertaken in the last 5 years which have resulted in partial or final settlement of the contract by arbitration or litigation in the courts: Amount of Name of Client & Project Contract Total Claims Settlement Amount Arbitrated of Claims or Litigated Has Bidder, or any representative or partner, ever failed to complete a contract? [ ] No [ ] Yes If yes, give details: FIRM NAME RESPONSIBLE BIDDER INFORMATION (continued) Has Bidder ever had any Payment/Performance Bonds called as a result of its work? [ I No [ ] Yes If yes, please state: Project Name Contracting Party Bond Amount Has Bidder changed bonding companies in the last 3 years? [ ] No [ ] Yes If yes, give details: Has Bidder ever filed for protection under any provision of the federal bankruptcy laws or state insolvency laws? [ ] No [ ] Yes If yes, give details: Has Bidder or any of its employees filed any claims with Washington State Workman's Compensation or other insurance company for accidents resulting in fatal injury or dismemberment in the past 5 years? [ ] No [ ] Yes If yes, please state: Date Type of Injury Agency Receiving Claim Will you, upon request from the City, fill out a detailed financial statement and furnish any other information that may be required by the City? [ ] No [ ] Yes The Bid Proposal signature warrants under penalty of perjury that the foregoing information is true and accurate to the best of his/her knowledge. The Bid Proposal signature authorizes the City of Auburn to verify all information contained herein. FIRM NAME PROPOSED EQUIPMENT AND MANPOWER SCHEDULE (Use additional sheets, if required) Equipment to be used: DESCRIPTION/TYPE YEAR CONDITION OWN/RENT Manpower schedule: FIRM NAME Local Agency Name Local Agency Subcontractor List CITY OF AUBURN Prepared in compliance with RCW 39.30.060 as amended Local Agency Address 75 W Main Street, Auburn, WA 98001 To Be Submitted with the Bid Proposal Project CP1807 - Water Meter Vaults and Lids Replacement Failure to list subcontractors with whom the bidder, if awarded the contract,will directly subcontract for performance of the work of heating,ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and electrical, as described in Chapter 19.28 RCW or naming more than one subcontractor to perform the same work will result in your bid being non-responsive and therefore void. Subcontractor(s)with whom the bidder will directly subcontract that are proposed to perform the work of heating, ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and electrical as described in Chapter 19.28 RCW must be listed below. The work to be performed is to be listed below the subcontractor(s) name. To the extent the Project includes one or more categories of work referenced in RCW 39.30.060, and no subcontractor is listed below to perform such work,the bidder certifies that the work will either(i) be performed by the bidder itself, or(ii) be performed by a lower tier subcontractor who will not contract directly with the bidder. Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Bidder's are notified that is the opinion of the enforcement agency that PVC or metal conduit,junction boxes, etc, are considered electrical equipment and therefore considered part of electrical work, even if the installation is for future use and no wiring or electrical current is connected during the project. FIRM NAME DOT Form 271-015A EF Revised 08/2012 BID BOND BOND NO. KNOW ALL MEN BY THESE PRESENTS: That we, , as Principal, (hereinafter called the "Principal"), and a corporation duly organized under the laws of the as Surety, (hereinafter called the "Surety"), are held and firmly bound unto the CITY OF AUBURN, Washington, as Obligee, (hereinafter called the "Obligee"), in the sum of FIVE PERCENT (5%) OF TOTAL AMOUNT BID not to exceed dollars ($ ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for WATER METER VAULTS AND LIDS REPLACEMENT,CP1807, 19-04 NOW THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the proper payment of labor and material in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void,otherwise to remain in full force and effect. SIGNED, SEALED AND DATED THIS DAY OF , 20 Name of Contractor Signed by Principal Surety Name Signed by Surety CITY OF AUBURN PUBLIC WORKS DEPARTMENT ADDENDUM NO. 2 DATE: December 13, 2019 Project Number CP1807, Contract No. 19-04 Water Meter Vaults and Lids Replacement Bid Opening Date: December 19, 2019 11:00 AM PT The following revisions, additions, and/or deletions are hereby made a part of the specifications and plans of the above-named contract and shall be taken into consideration by the bidder in submitting their bid: BID OPENING DATE: 1. The Bid Opening Date is revised to December 19, 2019. BID PROPOSAL PACKAGE: 2. REPLACE the entire Bid Proposal Package revised with Addendum No. 1 with the attached Revised Bid Proposal Package. The following is a summary of changes to the Bid Proposal Package revised with Addendum No. 1: a. Quantities for Bid Item Nos. 30 (Connect to Existing Water Main), 31 (Tapping Sleeve and Valve Assembly 6 x 4 In.), and 32 (Tapping Sleeve and Valve Assembly 12 x 4 In.). b. New Bid Items "Gate Valve 4 In.", "Gate Valve 6 In." and "Gate Valve 12 In." created. By signing the space provided in the "Receipt of Addenda" section of the "Bid Proposal", bidders certify and acknowledge receipt of Addendum No. 2 and to due consideration thereof in preparing and submitting the "Bid Proposal". Failure to acknowledge receipt of this Addendum on the "Bid Proposal" may be considered an irregularity in the "Bid Proposal". Prepared By: i a./ 131 19 Pro ect Manager Date Approved Bey: (7-- ,"---,--,,, 7./,,,7,, /.1////9 Jacob weeti , P.F. Date City engineer/Asst. Director of Engineering Services CITY OF AuBuRN WASHINGTON 2018 WSDOT CITY OF AUBURN KING AND PIERCE COUNTIES , WASHINGTON BID PROPOSAL PACKAGE for Project Number CP1807 WATER METER VAULTS AND LIDS REPLACEMENT Contract No. 19-04 Bid Opening Date: December 19, 2019 11:00 AM PT City of Auburn Engineering Division Public Works Department 25 West Main St. Auburn, WA 98001-4998 (253) 931-3010 Addendum No. 2 BIDDER'S CHECKLIST Bidder must execute and return with submittal: 1. PROPOSAL FORM The unit prices bid must be shown in the space provided. The proposal shall be filled in and signed by the bidder. 2. CONTRACTOR CERTIFICATION WAGE LAW COMPLIANCE 3. RESPONSIBLE BIDDER INFORMATION To show contractor's ability to perform jobs of a similar nature. 4. PROPOSED EQUIPMENT AND MANPOWER SCHEDULE Provide a complete list of equipment and manpower to be used on project. 5. LOCAL AGENCY SUBCONTRACTOR LIST List all subcontractors who are proposed to perform the work of heating, ventilation and air conditioning, plumbing, and electrical. Failure to submit this with the bid shall render the bid nonresponsive. (Form 271-015 included for this purpose). See Section 1-02.6 (Preparation of Proposal). 6. BID BOND This form is to be executed by the bidder and the Surety Company unless cash, cashier's check or a certified check in the amount of 5% of the total bid accompanies bid. The amount of this bond shall be not less than five percent (5%) of the total amount bid and may be shown in dollars or on a percentage basis. After the Contract is awarded, execute: 1. CONTRACT To be executed by the successful bidder in duplicate. 2. CONTRACT BOND To be executed by the successful bidder and his surety company in duplicate. 3. POWER OF ATTORNEY To be submitted in duplicate. 4. EVIDENCE OF INSURANCE To be submitted in duplicate. 5. PRELIMINARY CONSTRUCTION PROGRESS SCHEDULE Submitted in duplicate, showing the first 30 working days, to the Engineer 1 working day prior to the date of the Pre-construction Conference. To be provided in conformance with Section 1-08.3 (Progress Schedule) of the Standard Specifications. 6. REQUEST TO SUBLET WORK One copy for each subcontractor and lower tier subcontractor shall be submitted and approved by the City, prior to the subcontractor entering the project work site(s) to perform work. (Sample form is included). PROPOSAL FORM Page of CITY OF AUBURN Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Bid Opening: December 19, 2019 Bids received after this time will be returned to sender unopened in accordance with Section 1-02.9 (Delivery of Proposal) of the Specifications. The undersigned hereby certifies that: 1. The project site has been inspected. 2. The Bid Documents governing the work have been read and are thoroughly understood. 3. The bidder is willing and able to execute the Contract, provide a Contract Bond and Evidence of Insurance within 7 calendar days following the receipt of the dated "Notice of Award". 4. The "Contractor Certification Wage Law Compliance", "Responsible Bidder Information" and "Proposed Equipment and Manpower Schedule" forms have been completed and are enclosed with this Bid Proposal. 5. A "Local Agency Subcontractor List" per Section 1-02.6 (Preparation of Proposal) of the specifications has been completed and is enclosed with this Bid Proposal, if applicable. 6. A 5% Bid Deposit has been enclosed with this Bid Proposal. 7. All addendums have been acknowledged in the space provided in this Bid Proposal. 8. The bidder will promptly undertake the work upon receipt of the dated "Notice to Proceed" that will be issued within 5 working days of the contract execution date and complete the work embraced in this improvement in accordance with the Contract Documents at the following schedule of rates and prices, and it is understood that failure to complete the work within the time stated in Section 1-08.5 (Time for Completion) of the Specifications will be cause for assessment of liquidated damages in accordance with Section 1-08.9 (Liquidated Damages) of the Specifications. 9. The City may choose to include additive and/or alternate bid items or bid schedules on the Proposal Form and, if included, the City has the right to select any or all of the additive and/or alternate bid items or bid schedules. The additive and/or alternate bid items or bid schedules selected shall be added to the basic bid and the Contract award will be made based on the lowest and most acceptable total bid including selected additives and/or alternates. 10. The method of payment will be made only on the unit prices for items appearing on this Bid Proposal form. 11. The bidders must bid all items in the bid proposal. If any items are left blank or represent $0.00, the bid may be disqualified. NOTE: Unit prices for all items, all extensions and the total amount of bid must be shown. All proposals shall be typed or written in ink. FIRM NAME Addendum No. 2 PROPOSAL FORM Page2of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Schedule A: Water Improvements Bid or Sec. Description Quantity Unit Unit Total Price Item SP No. Price 1 Std 1-04 Minor Changes 25000 EST $1.00 $25,000.00 2 SP 1-05 Record Drawings(Minimum Bid $500) 1 LS $ $ 3 Std 1-07 SPCC Plan 1 LS $ $ 4 SP 1-07 Utility Potholing 1 EA $ $ 5 Std 1-09 Mobilization 1 LS $ $ 6 SP 1-10 Traffic Control Supervisor 1 LS $ $ 7 SP 1-10 Traffic Control Labor(Min. Bid $43.11 per 1000 HR $ $ hour) 8 SP 1-10 Sequential Arrow Sign 40 DAY $ $ 9 SP 1-10 Portable Changeable Message Sign 20 DAY $ $ 10 Std 2-01 Clearing and Grubbing 1 LS $ $ 11 SP 2-02 Remove and Reset Fence 25 LF $ $ 12 Std 2-02 Removal of Structures and Obstructions 1 LS $ $ 13 SP 2-02 Removal of Asphalt Pavement 95 SY $ $ 14 SP 2-02 Removal of Concrete Pavement 165 SY $ $ 15 SP 2-02 Remove Cement Concrete Sidewalk 175 SY $ $ 16 SP 2-02 Remove Cement Concrete Curb and 120 LF $ $ Gutter 17 Std 4-04 Crushed Surfacing Top Course 50 TON $ $ 18 Std 4-04 Crushed Surfacing Base Course 95 TON $ $ 19 Std 5-04 HMA Cl. 1/2-inch PG 64-22 140 TON $ $ 20 Std 5-04 Planing Bituminous Pavement 365 SY $ $ 21 SP 5-05 Cement Concrete Pavement-Including 180 SY $ $ Dowels FIRM NAME PROPOSAL FORM Page3of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Schedule A: Water Improvements Bid ord Sec. Description Quantity Unit Unit Total Price Item SP No. Price 22 SP 7-08 Pipe Foundation Material 30 TON $ $ 23 SP 7-08 Pipe Zone Bedding 125 TON $ $ 24 SP 7-08 Select Pipe Trench Backfill 215 TON $ $ 25 Std 7-08 Shoring or Extra Excavation Class B 1240 SF $ $ 26 Std 7-08 Plugging Existing Pipe 8 EA $ $ 27 SP 7-09 Special Class 52 Ductile Iron Pipe for 100 LF $ $ Water Main, 3 In. Diam. 28 SP 7-09 Special Class 52 Ductile Iron Pipe for 210 LF $ $ Water Main, 4 In. Diam. 29 SP 7-09 2-inch Blowoff Asssembly 1 EA $ $ 30 SP 7-09 Connect to Existing Water Main 11 EA $ $ 31 Std 7-12 Tapping Sleeve and Valve Assembly 6 1 EA $ $ x4ln. 32 Std 7-12 Tapping Sleeve and Valve Assembly 12 2 EA $ $ x 4 1n. 33 Std 7-12 Tapping Sleeve and Valve Assembly 20 2 EA $ $ x 4 In. 34 Std 7-12 Gate Valve 4 In. 2 EA $ $ 35 Std 7-12 Gate Valve 6 In. 1 EA $ $ 36 Std 7-12 Gate Valve 12 In. 4 EA $ $ 37 SP 7-12 Adjust Valve Box 5 EA $ $ 38 SP 7-14 Hydrant Assembly 1 EA $ $ 39 SP 7-20 3 inch Diam. Water Meter and Vault 6 EA $ $ 40 SP 7-20 4 inch Diam. Water Meter and Vault 2 EA $ $ 41 SP 7-20 Replace Water Meter Vault Lid 1 EA $ $ 42 Std 8-01 Erosion/Water Pollution Control 7500 EST $ 1.00 $7,500.00 FIRM NAME Addendum No. 2 PROPOSAL FORM Page4of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Schedule A: Water Improvements Bid Soo Sec. Description Quantity Unit Unit Total Price Item SP No. Price 43 Std 8-01 Inlet Protection 3 EA $ $ 44 SP 8-02 Topsoil Type A 20 CY $ $ 45 Std 8-02 Sod Installation 55 SY $ $ 46 SP 8-02 Bark Mulch 2 CY $ $ 47 Std 8-04 Cement Conc. Traffic Curb and Gutter 120 LF $ $ 48 Std 8-09 Raised Pavement Marker Type 2 10 EA $ $ 49 Std 8-14 Cement Conc. Sidewalk 175 SY $ $ 50 SP 8-21 Remove Traffic Sign 2 EA $ $ 51 SP 8-21 Traffic Sign 2 EA $ $ 52 Std 8-22 Paint Line 250 LF $ $ 53 Std 8-22 Painted Wide Lane Line 40 LF $ $ 54 Std 8-22 Plastic Crosswalk Line 18 SF $ $ 55 Std 8-22 Plastic Traffic Arrow 4 EA $ $ 56 Std 8-23 Temporary Pavement Marking -Short 290 LF $ $ Duration Subtotal Schedule A $ FIRM NAME Addendum No. 2 PROPOSAL FORM Page5of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Bid Summary: Subtotal Schedule A $ WA State Sales Tax Schedule A (10.0%) $ Total Gross Bid (Subtotal Schedule A + Sales Tax) $ If sales tax is shown for a schedule above sales tax should not be included in bid item prices for that schedule (Rule 170). If sales tax is not identified above Contractor shall include appropriate sales tax in each bid item price as applicable (Rule 171). RECEIPT OF ADDENDA. I certify and acknowledge receipt of the following Addenda to the Bid Documents and that due consideration thereof has been used in preparing and submitting this Bid Proposal. Addendum Date of Receipt Signed No. of Addendum Acknowledgment 1 2 3 4 (NOTE: Failure to herein acknowledge receipt of the addenda may be considered an irregularity in this proposal.) FIRM NAME PROPOSAL FORM Page6of6 Water Meter Vaults and Lids Replacement Contract No. 19-04 Project No. CP1807 Submitted by: I certify under penalty of perjury under the laws of the State of Washington that I am the official authorized to submit this Bid Proposal on behalf of: FIRM NAME: Address: Phone #: Email: Authorized Official: Title: (Please print name) Date: (Signature) Authorized Official: Title: (Please print name) Date: (Signature) Place of Execution: City and State NOTE: 1. Bidder is a(n):[ ] Corporation [ ] Individual [ ] Partnership [ ] Joint Venture [ ] Other 2. If the bidder is a corporation, its duly authorized officials must execute this proposal. Incorporated in the State of . State Contractor State Contractor License #: License Expiration Date: State Unified Business Employment Security Identifier (UBI) #: Department#: State Excise Tax Registration #: Federal Tax ID #: Construction Contractors: Please use the following City of Auburn Tax Code Numbers on retail sales where the labor and services are primarily performed in Auburn; 1. Number 1702 when the work is performed in King County 2. Number 2724 when the work is performed in Pierce County Submit Bid Proposal to: Office of City Clerk City of Auburn 25 West Main Street Auburn, WA. 98001-4998 CITY OF AUB ..- WASHINGTON Contractor Certification Wage Law Compliance - Responsibility Criteria Washington State Public Works Contracts FAILURE TO RETURN THIS CERTIFICATION AS PART OF THE BID PROPOSAL PACKAGE WILL MAKE THIS BID NONRESPONSIVE AND INELIGIBLE FOR AWARD I hereby certify, under penalty of perjury under the laws of the State of Washington, on behalf of the firm identified below that, to the best of my knowledge and belief, this firm has NOT been determined by a final and binding citation and notice of assessment issued by the Washington State Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the Call for Bids. Bidder Name: Name of Contractor/Bidder-Print full legal entity name of firm By: Signature of authorized person Print Name of person making certifications for firm Title: Place: Title of person signing certificate Print city and state where signed Date: WSDOT Form 272-009 08/2017 RESPONSIBLE BIDDER INFORMATION Bidder has been in business continuously from (year). Bank Reference: Bank Name Account Officer Phone No. Number of regular full-time employees: Number of projects in the past 5 years completed: ahead of schedule on schedule behind schedule Bidder has had experience in work comparable to that required for this Project: As a prime contractor for years. As a subcontractor for years. List the supervisory personnel to be employed by the Bidder and available for work on this project (Project manager, Foreman, Site Superintendent, Engineer, etc.): Name Title Years with firm List below, non-City of Auburn construction work successfully completed by the bidder within the past five years which was similar in size, scope, and difficulty to the work herein being bid upon. Year Contract Project Name Completed Amount Owner/Reference Name & Phone List all projects undertaken in the last 5 years which have resulted in partial or final settlement of the contract by arbitration or litigation in the courts: Amount of Name of Client & Project Contract Total Claims Settlement Amount Arbitrated of Claims or Litigated Has Bidder, or any representative or partner, ever failed to complete a contract? [ ] No [ ] Yes If yes, give details: FIRM NAME RESPONSIBLE BIDDER INFORMATION (continued) Has Bidder ever had any Payment/Performance Bonds called as a result of its work? [ ] No [ ] Yes If yes, please state: Project Name Contracting Party Bond Amount Has Bidder changed bonding companies in the last 3 years? [] No [] Yes If yes, give details: Has Bidder ever filed for protection under any provision of the federal bankruptcy laws or state insolvency laws? [ ] No [ ] Yes If yes, give details: Has Bidder or any of its employees filed any claims with Washington State Workman's Compensation or other insurance company for accidents resulting in fatal injury or dismemberment in the past 5 years? [ ] No [ ] Yes If yes, please state: Date Type of Injury Agency Receiving Claim Will you, upon request from the City, fill out a detailed financial statement and furnish any other information that may be required by the City? [ ] No [ ] Yes The Bid Proposal signature warrants under penalty of perjury that the foregoing information is true and accurate to the best of his/her knowledge. The Bid Proposal signature authorizes the City of Auburn to verify all information contained herein. FIRM NAME PROPOSED EQUIPMENT AND MANPOWER SCHEDULE (Use additional sheets, if required) Equipment to be used: DESCRIPTION/TYPE YEAR CONDITION OWN/RENT Manpower schedule: FIRM NAME Local Agency Name Local Agency Subcontractor List City OF AUBURN Prepared in compliance with RCW 39.30.060 as amended Local Agency Address 25 W Main Street,Auburn,WA 98001 To Be Submitted with the Bid Proposal Project CP1807 - Water Meter Vaults and Lids Replacement Failure to list subcontractors with whom the bidder, if awarded the contract,will directly subcontract for performance of the work of heating,ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and electrical, as described in Chapter 19.28 RCW or naming more than one subcontractor to perform the same work will result in your bid being non-responsive and therefore void. Subcontractor(s)with whom the bidder will directly subcontract that are proposed to perform the work of heating, ventilation and air conditioning, plumbing, as described in Chapter 18.106 RCW, and electrical as described in Chapter 19.28 RCW must be listed below. The work to be performed is to be listed below the subcontractor(s) name. To the extent the Project includes one or more categories of work referenced in RCW 39.30.060, and no subcontractor is listed below to perform such work,the bidder certifies that the work will either(i) be performed by the bidder itself, or(ii) be performed by a lower tier subcontractor who will not contract directly with the bidder. Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed Subcontractor Name Work to be Performed * Bidder's are notified that is the opinion of the enforcement agency that PVC or metal conduit,junction boxes, etc, are considered electrical equipment and therefore considered part of electrical work, even if the installation is for future use and no wiring or electrical current is connected during the project. FIRM NAME DOT Form 271-015A EF Revised 08/2012 BID BOND BOND NO. KNOW ALL MEN BY THESE PRESENTS: That we, , as Principal, (hereinafter called the "Principal"), and a corporation duly organized under the laws of the as Surety, (hereinafter called the "Surety"), are held and firmly bound unto the CITY OF AUBURN, Washington, as Obligee, (hereinafter called the"Obligee"), in the sum of FIVE PERCENT (5%) OF TOTAL AMOUNT BID not to exceed dollars ($ ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for WATER METER VAULTS AND LIDS REPLACEMENT,CP1807, 19-04 NOW THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the proper payment of labor and material in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. SIGNED, SEALED AND DATED THIS DAY OF , 20 Name of Contractor Signed by Principal Surety Name Signed by Surety