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HomeMy WebLinkAbout5639 ACCEPTANCE OF COMPENSATION &RELEASE OF ALL CLAIMS City Safety Improvement Project Number: 315034 Petersen Brothers hereby indicates agreement with, and acceptance of the total Contract Price of$27,319.91, including Washington State sales and/or use taxes,and the final Contract Time of 4 days, as full and final compensation for all Work performed in connection with Project N umber 315034, and does hereby release the City of Bremerton from all claims, liability, demands, damages and actions of any kind whatsoever,arising from performance of that Contract. Petersen Brother • By: Date: 1!I C l,� )5) ZO� Title: Tc10 'dei �/ Certificate of Notary Subscribed and sworn to before me this ) --day of 2 ••`%10‘. LYAWN edet,d .......... cr, � Not s p�8 cy Z ��i��1WASH;NG .ti HI SCOX Hiscox Insurance Company Inc. Policy Number US UEN 2717680.16 Named Insured: XVIII Entertainment, LLC Endorsement Number: 6 Endorsement Effective: 1-12-16 Additional Premium Included Blanket Additional Insured Endorsement In consideration of the additional premium charged as stated above and on the understanding that all other terms, conditions and exclusions remain unchanged, it is agreed that this endorsement modifies only the terms and conditions of the Commercial General Liability Coverage Section. Name of Person or Organization (Additional Insured) CITY OF BREMERTON Attn: Risk Management 345 6th Street Suite 600 Bremerton,WA 98337 I. It is agreed that under WHO IS COVERED any person or organization from whom you lease a premises, and with whom you have agreed through a written or oral contract to provide insurance as is afforded by this Coverage Section,are added as insureds. In the case of oral agreements,the agreement must also be evidenced by a certificate of insurance issued for you by us or on our behalf. However,this insurance applies to such an insured only to the extent: A. of liability arising out of your business operations; B. you would have been entitled to coverage under the Commercial General Liability Coverage Section for the same claim or suit:and C. of liability arising out of the ownership, maintenance or use of that particular part of such premises leased to you. II. It is agreed that under WHO IS COVERED any person or organization from whom you lease equipment or props, sets and wardrobe, and with whom you have agreed through a written or oral contract to provide insurance as is afforded by this Coverage Section, are added as insureds. In the case of oral agreements,the agreement must also be evidenced by a certificate of insurance issued for you by us or on our behalf. However,this insurance applies to such an insured only to the extent: A. of liability arising out of your business operations; B. you would have been entitled to coverage under the Commercial General Liability Coverage Section for the same claim or suit; and C. of liability arising out of the ownership, maintenance or use of that particular part of such premises leased to you. III. It is agreed that under WHO IS COVERED any: A. financial institution or any entity that has a fiduciary interest in your business; B. State, Municipality or other Political Subdivision; C. payroll service; D. advertising agency and/or advertiser; E. distributor; G. record label;or Includes copyrighted material of Insurance Services Office,Inc.,with its permission. EGL E4310 CW(09-12) Page 1 of 2 HI SC J)( Hiscox Insurance Company Inc. H. personal service or loan out corporation while acting within the scope of their duties for you, with whom you have agreed through a written or oral contract to provide insurance as is afforded by this Coverage Section, are added as insureds. In the case of oral agreements,the agreement must also be evidenced by a certificate of insurance issued for you by us or on our behalf. However,this insurance applies to such an insured only to the extent: A. of liability arising out of your business operations: B. you would have been entitled to coverage under the Commercial General Liability Coverage Section for the same claim or suit. The title of the endorsement is solely for ease of reference and forms no part of the terms and conditions of coverage. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. EGL E4310 CW(09-12) Page 2 of 2 644fri,d- AGENDA BILL CITY OF BREMERTON 7E CITY COUNCIL SUBJECT: Public Works Agreement with PW Committee Date: November 1, 2016 Peterson Brothers for the Tracyton Beach COUNCIL MEETING Date: November 2, 2016 Road Guardrail Construction Project Department: PW&U Presenter: Tom Knuckey Phone: (360) 473-2376 SUMMARY: Staff have developed a design to construct guardrail on Tracyton Beach Road at the most critical locations. The project was initially bid using the small works roster process and only a single bid was received which exceeded the project budget. The project was then advertised and on October 12th a single bid was received which again exceeded the original project budget. The bid was from Peterson Brothers in the amount of$127,839.04, including sales tax. After the design and construction management was updated, the total cost of the work is now estimated at $156,000. Funding for the work will be from the Street Operating Budget in the TBD Department; there are sufficient funds available for the work. ATTACHMENTS: 1) Contract; 2) Site Plan; 3) Bid Tab FISCAL IMPACTS (Include Budgeted Amount): The project is funded in the Street Fund TBD Department. PW COMMITTEE AGENDA: ❑ No Presentation ❑x Full Presentation PW COMMITTEE ACTION: ❑ Consent Agenda General Business ❑ Public Hearing RECOMMENDED MOTION: Move to approve the Public Works Agreement with Peterson Brothers for the Tracyton Beach Road Guardrail Construction Project; and authorize the Mayor to finalize and execute the agreement with substantially the same terms and conditions as presented. COUNCIL ACTION: [Approve ❑ Deny ❑ Table ❑ Continue f1 No Action Form Updated 01/07/15 zv PUBLIC WORKS AGREEMENT FOR TRACYTON BEACH ROAD GUARDRAIL PROJECT THIS AGREEMENT, is entered into between the City of Bremerton, a Washington Municipal Corporation("City"), and Petersen Brothers, Inc. ("Contractor"), whose mailing address is 2008 E Valley Hwy E, Sumner, WA 98340. The parties agree as follows: 1. CONTRACTOR SERVICES. The Contractor shall perform the following services for the City: Construction of guardrail on Tracyton Beach Road. 2. TIME OF COMPLETION. Contractor shall complete the work within ten (10) working days from the date of issuance of the City's Notice to Proceed. 3. COMPENSATION. The City shall pay the Contractor the total amount of $ 127,839.04 . Applicable Washington State Retail Sales Tax on this contract shall be governed by WAC 458-20-171 and its related rules for the work contemplated in this agreement. The Contractor shall invoice the City monthly. The City will pay for the portion of the work described in the invoice that has been completed by the Contractor and approved by the City. The City payment shall not constitute a waiver of the City's right to final inspection and acceptance of the project. A. Performance Bond. Pursuant to Chapter 39.08 RCW, the Contractor, shall provide the City a performance bond for the full contract amount to be in effect until sixty(60)days after the date of final acceptance, or until receipt of all necessary releases from the State Department of Revenue and the State Department of Labor and Industries and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. B. Retainage. The City shall hold back a retainage in the amount of five percent (5%) of any and all payments made to contractor for a period of sixty (60) days after the date of final acceptance, or until receipt of all necessary releases from the State Department of Revenue and the State Department of Labor & Industries and until settlement of any liens filed under Chapter 60.28 RCW, whichever is later. C. Defective or Unauthorized Work. The City reserves its right to withhold payment from Contractor for any defective or unauthorized work. Tracyton Beach Guardrail Project#4273 CD-10 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen Brothers,Inc. ) Defective or unauthorized work includes, without limitation: work and materials that do not conform to the requirements of this agreement; and extra work and materials furnished without the City's written approval. If Contractor is unable, for any reason, to satisfactorily complete any portion of the work, the City may complete the work by contract or otherwise, and Contractor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Contract price specified above. The City further reserves its right to deduct the cost to complete the Contract work, including any Additional Costs, from any and all amounts due or to become due the Contractor. D. Final Payment: Waiver of Claims. THE MAKING OF FINAL PAYMENT (EXCLUDING WITHHELD RETAINAGE) SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND PROPERLY MADE AND IDENTIFIED BY CONTRACTOR AS UNSETTLED AT THE TIME REQUEST FOR FINAL PAYMENT IS MADE. 4. INDEPENDENT CONTRACTOR. Contractor is and shall be at all times acting as an independent contractor and not as an employee of the City. The Contractor shall secure at its expense,and shall be responsible for all payments of income tax, social security, state disability insurance compensation, unemployment compensation, and all other payroll deductions for the Contractor, officer, agents, employees and sub-contractors. The Contractor shall also secure all applicable business licenses, if required, in connection with the contract services, including all required licenses for Contractor's officers, agents, employees and sub-contractors. 5. TERMINATION. The City may terminate this agreement for good cause. "Good cause" shall include, without limitation, any one or more of the following events: A. The Contractor's refusal or failure to supply a sufficient number of properly skilled workers or proper materials for completion of the Contract work. B. The Contractor's failure to complete the work within the time specified in this agreement. C. The Contractor's failure to make full and prompt payment to subcontractors or for material or labor. D. The Contractor's persistent disregard of federal, state or local laws, rules or regulations. E. The Contractor's filing for bankruptcy or becoming adjudged bankrupt. If the City terminates this agreement for good cause, the Contractor shall not receive any further monies due under this agreement until the Contract work is completed. Tracyton Beach Guardrail Project#4273 CD-11 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen BrothL)s.Inc ) 6. PREVAILING WAGES. Contractor shall file a "Statement of Intent to Pay Prevailing Wages," with the State of Washington Department of Labor & Industries prior to commencing the Contract work. Contractor shall pay prevailing wages and comply with Chapter 39.12 of the Revised Code of Washington, as well as any other applicable prevailing wage rate provisions. The latest prevailing wage rate revision issued by the Department of Labor and Industries is attached. 7. CHANGES. The City may issue a written work change directive for any change in the Contract work during the performance of this agreement. If the Contractor determines, for any reason,that a change order is necessary,Contractor must submit a written change order request to the City's project manager within two (2) business days of the date the Contractor knew or should have known of the facts and events giving rise to the requested change. If the City determines that the change increases or decreases the Contractor's costs or time for performance, the City will make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the Contractor on all equitable adjustments. However, if the parties are unable to agree, the City will determine the equitable adjustment as it deems appropriate. The Contractor shall proceed with the change order work upon receiving a written work change directive or change order from the City. If the Contractor fails to require a change order within the time allowed, the Contractor waives its right to make any claim or submit subsequent change order requests for that portion of the contract work. If the Contractor disagrees with the equitable adjustment the Contractor must complete the change order work; however,the Contractor may elect to protest the adjustment as provided below: A. Procedure and Protest by the Contractor. If the Contractor disagrees with anything required by a work change directive or change order, including any direction, instruction, interpretation, or determination by the City, the Contractor shall: 1. Immediately give a signed written notice of protest to the City; 2. Supplement the written protest within fourteen (14) calendar days with a written statement that provides the following information: a. The date of the Contract's protest. b. The nature and circumstances that caused the protest. c. The provisions in this agreement that support the protest. d. The estimated dollar cost, if any, of the protested work and how that estimate was determined. e. An analysis of the progress schedule showing the schedule change or disruption if the Contractor is asserting a schedule change or disruption. The Contractor shall keep complete records of extra costs and time incurred as a result of the protested work. The City shall have access to any of the Contractor's records needed for evaluating the protest. Tracyton Beach Guardrail Project#4273 CD-12 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen Brothers.inc. 3. The City will evaluate all protests, provided the procedures in this section are followed. If the City determines that a protest is valid, the City will adjust payment for work or time by an equitable adjustment. No adjustment will be made for an invalid protest. B. Contractor's Duty to Complete Protested Work. In spite of any protest, the Contractor shall proceed promptly with the work as the City has ordered. C. Contractor's Acceptance of Changes. The Contractor accepts all requirements of a change order by: (1) endorsing it, (2) writing a separate acceptance, or(3)not protesting in the way this section provides. A change order that is accepted by Contractor as provided in this section shall constitute full payment and final settlement of all claims for contract time and for direct, indirect and consequential costs, including costs of delays related to any work, either covered or affected by the change. D. Failure to Protest Constitutes Waiver. By not protesting as this section provides, the Contractor also waives any additional entitlement and accepts from the City any written order (including directions, instructions, interpretations, and determination). E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures of this section,the Contractor completely waives any claims for protested work and accepts form the City any written order (including directions, instructions, interpretations, and determination). 8. CLAIMS. The Contractor shall give written notice to the City of all claims other than change orders within fourteen (14) calendar days of the occurrence of the events giving rise to the claims. Any claim for damages, additional payment for any reason, or extension of time, whether under this agreement or otherwise, shall be conclusively deemed to have been waived by the Contractor unless a timely written claim is made in strict accordance with the applicable provisions of this agreement; or, if(and only if) no such provision is applicable, unless that claim is set forth in detail in writing and received by the City within seven (7) calendar days from the date Contractor knew, or should have known, of the facts giving rise to the claim. At a minimum, a Contractor's written claim must include the information set forth regarding protests in Section 7.A.2.a.-e. FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY. Contractor must, in any event, file any claim or bring any suit arising from or connected with this agreement within 120 calendar days from the date the contract work is complete. Tracyton Beach Guardrail Project#4273 CD-13 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen Brothers,Inc. ) 9. WARRANTY. The Contractor shall correct all defects in workmanship and materials within one year from the date of the City's acceptance of the Contract work. When defects are corrected, the warranty for that portion of the work shall extend for one year form the date such correction is completed and accepted by the City. The Contractor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Contractor does not accomplish the corrections within a reasonable time, the City may complete the corrections and the Contractor shall pay all costs incurred by the City in order to accomplish the correction. 10. INDEMNIFICATION. Contractor shall defend, indemnify and hold the City, its officer, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits including all legal costs and attorney fees, arising out of or in connection with the performance of this agreement, except for injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Contractor's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Contractor and the City, its officials, employees, agents and volunteers, the Contractor's liability hereunder shall be only to the extent of the Contractor's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THIS INDEMNIFICATION CONSTITUTES THE CONTRACTOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSE OF THIS INDEMNIFICATION. THE PARTIES ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. The provisions of this section shall survive the expiration or termination of this agreement. 11. INSURANCE. The Contractor shall procure and maintain for the duration of this agreement insurance of the types and in the amounts described below against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work by the Contractor,its agents,representative,employees,subconsultants or subcontractors. Before beginning work on the project described in this agreement, the Contractor shall provide a Certificate of Insurance evidencing: 1. Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and 2. Commercial General Liability insurance written on an occurrence basis with limits no less than $1,000,000 combined single limit per occurrence Tracyton Beach Guardrail Project#4273 CD-14 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen Brothers,Inc • and $2,000,000 general aggregate for personal injury, bodily injury and property damage. Coverage shall include but not be limited to: blanket contractual; products/completed operations/broad form property damage; explosion, collapse and underground (XCU); and employer's liability. 3. Excess Liability insurance with limits not less than $1,000,000 per occurrence and aggregate. Any payment of deductible or self insured retention shall be the sole responsibility of the Contractor. The City,its officials,employees,agents and volunteers shall be named as an additional insured on the insurance policy, as respects work performed by or on behalf of the Contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The Contractor's insurance shall contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. The Consultant's insurance shall be primary and non-contributory insurance as respects the City and shall contain a waiver of subrogation against the City for claims arising out of any operations, liabilities and obligations to which coverage applies. It shall be an affirmative obligation upon Consultant to advise the City's Risk Manager by fax at (360) 473-5161, or by certified mail,return receipt requested to City of Bremerton,attn:Risk Management,345 6`h Street, Suite 600, Bremerton, WA 98337 within two days of the cancellation, suspension or substantive change of any insurance policy set out herein, and failure to do so shall be construed to be a breach of this Agreement. The City reserves the right to receive a certified copy of all the required insurance policies. 12. MISCELLANEOUS. A. Nondiscrimination. In the hiring of employees for the performance of work under this Agreement or any sub-contract hereunder, the Contractor, its sub-contractors, or any person acting on behalf of such Contractor or sub-contractor shall not,by reason of race,religion, color, sex, national origin, or the presence of any sensory, mental, physical disability, or sexual orientation discriminate against any person who is qualified and available to perform the work to which the employment relates. B. Compliance with Laws. Contractor shall comply with all federal, state and local laws, rules and regulations throughout every aspect in the performance of this agreement. C. Work Performed at Contractor's Risk. Contractor shall take all precautions necessary and shall be responsible for the safety of its employees, agents, and subcontractors in Tracyton Beach Guardrail Project#4273 CD-15 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen Brothers,Inc. ) • the performance of this agreement. All work shall be done at Contractor's own risk,and Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. D. Nonwaiver of Breach. The failure of the City to insist upon strict performance of any of the terms and rights contained herein, or to exercise any option herein conferred in one or more instances, shall not be constructed to be a waiver or relinquishment of those terms and rights and they shall remain in full force and effect E. Governing Law. This agreement shall be governed and construed in accordance with the laws of the State of Washington. If any dispute arises between the City and Contractor under any of the provisions of this agreement, resolution of that dispute shall be available only through the jurisdiction, venue and rules of the Kitsap County Superior Court, Kitsap County, Washington. F. Attorney's Fees. To the extent not inconsistent with RCW 39.04.240,in any claim or lawsuit for damages arising from the parties' performance of this agreement, each party shall be responsible for payment of its own legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit; however, nothing in this subsection shall limit the City's right to indemnification under Section 10 of this agreement. G. Written Notice. All communications regarding this agreement shall be sent to the parties at the addresses listed on the signature page of this agreement, unless otherwise notified. Any written notice shall become effective upon delivery, but in any event three (3) calendar days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated on this agreement. H. Assignment. Any assignment of this agreement by the Contractor without the written consent of the City shall be void. I. Modification. No waiver, alteration, or modification of any of the provisions of this agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Contractor. J. Severability. If any one or more sections, sub-sections, or sentences of this agreement are held to be unconstitutional or invalid, that decision shall not affect the validity of the remaining portion of this agreement and the remainder shall remain in full force and effect. K. Entire Agreement. The written provisions and terms of this agreement, together with any attached Exhibits, supersede all prior verbal statements by any representative of the City, and those statements shall not be construed as forming a part of or altering in any manner this agreement. This agreement and any attached Exhibits contain the entire agreement between the parties. Should any language in any Exhibit to this agreement conflict with any language contained in this agreement,the terms of this agreement shall prevail. Tracyton Beach Guardrail Project#4273 CD-16 PUBLIC WORKS AGREEMENT (between City of Bremerton and Peterson Brothers,Inc. IN WITNESS WHEREOF, the parties below have executed this agreement. CONT' • C 0 Petersen Brothers, Inc. THE CITY OF BREMERTON J) pr2 i ,..:, / Print Name: Ronald G. Petersen Print Na aria/* Lent Title: President Title: •r DATE 11-7-16 DATE /Z —°'5.' 24/8 Notices to be sent to: Notices to be sent to: CONTRACTOR: CITY OF BREMERTON: Petersen Brothers, Inc. Attn: City Clerk 2008 E Valley Hwy E 345 6th Street, Suite 600 Sumner, WA 98340 Bremerton, WA 98310 (360) 473-5323 (360) 473-5200 (facsimile) APPROVED AS TO FORM: 1 `�� ... Bremert. Attorn 7 ATTES . Bremerton City Clerk R:\LEGAL\Contracts\FORMS,ShortForm.PW.Agr.doc Tracyton Beach Guardrail Project#4273 CD-17 PUBLIC WORKS AGREEMENT (between City of Bremerton and Petersen Brothers,Inc. ) PAYMENT AND Travelers Casualty and Surety Company of America PERFORMANCE Hartford, CT 06183 BOND Bond No.: 106613728 KNOW ALL PERSONS BY THESE PRESENTS, That we, Petersen Brothers,Inc. , as principal, (hereinafter called the "Principal"), and Travelers Casualty and Surety Company of America a Connecticut corporation, as surety, (hereinafter called the "Surety"), are held and firmly bound unto City of Bremerton , as Obligee, in the sum of One Hundred Twenty Seven Thousand Eight Hundred Thirty Nine and 04/100 Dollars ( $127,839.04 ) for the payment whereof said Principal and Surety bind themselves,jointly and severally, as provided herein. 1 WHEREAS, the Principal has entered into a Contract with Obligee dated 05 Pair t6 1, to perform construction work for Construction of guardrail on Tracyton Beach Road-Project No.4273 ("Contract"). NOW, THEREFORE, the condition of this obligation is such that if Principal shall promptly and faithfully perform the Construction Work to be performed under the Contract, and shall promptly make payment to Claimants, as hereinafter defined, for all labor and material actually used, consumed or incorporated in the performance of the Construction Work under the Contract, then this obligation shall be null and void; otherwise to remain in full force and effect. Surety's obligations hereunder to Obligee shall not arise unless Principal is in default under the Contract for failing to perform the Construction Work, and has been declared by Obligee to be in default under the Contract for failing to perform the Construction Work; and Obligee has performed its obligations under the Contract. In such event,.Surety shall have a reasonable period of time to: 1. Upon entering into an acceptable written takeover agreement with Obligee, undertake to perform and complete the Construction Work to be done under the Contract; or 2. Obtain bids or negotiated proposals from qualified contractors for a contract for completion of the Construction Work to be done under the Contract, arrange for a contract to be prepared for execution by Obligee and contractor, to be secured with performance and payment bonds executed by a qualified surety; or 3. Waive its right to perform or complete the Construction Work pursuant to paragraphs 1 and 2 above, and with reasonable promptness under the circumstances: (a) After investigation, determine the amount for which it may be liable to the Obligee and, as soon as practicable after the amount is determined, tender payment therefor to the Obligee; or (b) Deny liability in whole or in part and notify the Obligee citing reasons therefor. 4. The Contract balance, as defined below, shall be credited against the reasonable construction cost of completing the Construction Work to be performed under the Contract. If completed by Obligee pursuant to paragraphs 2 or 3 above, and the reasonable construction cost of completing the Construction Work exceeds the Contract balance, Surety shall pay to Obligee such excess, but in no event shall the aggregate liability of Surety exceed the amount of this bond. If Surety completes the work pursuant to paragraph 1 above, that portion of the Contract balance as may be required to complete the Construction Work to be done under the Contract and to reimburse Surety for its outlays shall be paid to Surety at the times and in the manner as said sums would have been payable to Principal had there been no default under the Contract. To the extent that Surety's outlays exceed the Contract balance paid to Surety by Obligee, Surety shall be entitled to a dollar for dollar reduction of its liability under this bond, and Surety's aggregate liability shall not exceed the penal sum of this bond. The term "Contract balance" as used herein shall mean the total amount payable by Obligee under the Contract and any amendments thereto, less the amounts properly paid by Obligee to Principal under the Contract. The term "Construction Work" as used herein shall mean the providing of all labor and/or material necessary to complete Principal's scope of work under the Contract. Notwithstanding any language in the Contract to the contrary, the Contract Payment and Performance Bond—Page 1 of 3 balance shall not be reduced or set off on account of any obligation, contractual or otherwise, except the reasonable construction cost incurred in completing the Construction Work. 5. Any suit by Obligee under this bond must be instituted before the earlier of: (a) the expiration of one year from the date of substantial completion of the Construction Work, or (b) one year after Principal ceased performing the Construction Work, excluding warranty work. If the public works bond statutes in the location where the Construction Work is being performed contains a statute of limitations for suits on the performance bond, then the limitation period set forth herein shall be read out of this bond and the statute of limitation set forth in the public works bond statutes shall be read into this bond. If the limitation set forth in this bond is void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable, and said period of limitation shall be deemed to have accrued and shall commence to run no later than (y) the date of substantial completion of the Construction Work, or (z) the date Principal ceased performing Construction Work, excluding warranty work, whichever occurs first. 6. A Claimant is defined as one other than Obligee having a contract with Principal or with a direct subcontractor of Principal to supply labor and/or materials and said labor and/or material is actually used, consumed or incorporated in the performance of the Construction Work under the Contract. 7. Principal and Surety hereby jointly and severally agree with Obligee that every Claimant as herein defined who has not been paid in full before the expiration of a period of ninety (90) days after the date on which the last of such Claimant's work or labor was done or performed or materials were furnished by such Claimant, may bring suit on this bond, prosecute the suit to final judgment for the amount due under Claimant's contract for the labor and/or material supplied by Claimant which was actually used, consumed or incorporated in the performance of the Construction Work, and have execution thereon; provided, however, that a Claimant having a direct contractual relationship with a subcontractor of Principal shall have a right of action on this bond only if said Claimant notifies Surety in writing of its claim within ninety (90) days from the date on which said Claimant did or supplied the last labor and/or materials for which the claim is made. Obligee shall not be liable for the payment of any costs or expenses of any such suit. 8. No suit or action shall be commenced hereunder by any Claimant after the expiration of the earlier of: (a) one year after the day on which Claimant last supplied the labor and/or materials for which the claim is made; or (b) the limitation period set forth in the public works bond statutes, if any, in the location where the construction work is being performed. Any limitation contained in this bond which is prohibited by any law controlling in the state where the suit is filed shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by the law of that state, and said period of limitation shall be deemed to have accrued and shall commence to run on the day Claimant last supplied the labor and/or materials for which the claim is made. 9. No suit or action shall be commenced hereunder by Obligee or any Claimant other than in a state court of competent jurisdiction in the county or other political subdivision of the state in which the project, or any part thereof, is situated, or in the United States District Court for the district in which the project, or any part thereof, is situated, and not elsewhere. 10. The amount of this bond shall be reduced by and to the extent of any payment or payments made by Surety in good faith hereunder whether made directly to Obligee or Claimant(s) or otherwise in discharge of Principal's obligations. Surety's liability hereunder to Obligee and all Claimants is limited, singly, or in the aggregate, to the penal sum of the bond set forth herein. Surety may, at its option, discharge all obligations under this bond by interpleading into the registry of any court of competent jurisdiction of the full unused penal sum of this bond, or such portion thereof that will satisfy the obligations owed to Obligee and/or Claimant(s). No right of action shall accrue on this bond to any person or entity other than Obligee and/or Claimant(s). The bond shall not afford coverage for any liability of Principal for tortious acts, whether or not said liability is direct or is imposed by the Contract, and shall not serve as or be a substitute for or supplemental to any liability or other insurance required by the Contract. Payment and Performance Bond—Page 2 of 3 11. This bond is provided to comply with a statutory or other legal requirement for performing construction contracts for public owners in the location where the construction work is • being performed. Except as provided in paragraphs 5 and 8 above, all provisions in the bond which are in addition to or differ from those statutory or legal requirements shall be read out of this bond, and all pertinent statutes and other legal requirements shall be read into the bond. This bond is a statutory bond, not a common law bond. Signed this 8th day of November , 2016 • Petersen Brothers,Inc. (Principal) By: no-1 d G. ���,, ere si -e �f Travelers Casualty and Surety Company of America By: Juli Craker, , Attorney-in-Fact Payment and Performance Bond—Page 3 of 3 A WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER • POWER OF ATTORNEY TRAVELERSJ� Farmington Casualty Company St.Paul Mercury Insurance Company • Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 229340 Certificate No. 006351502 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the ' laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Karen J.Smith,Julie Craker,Thomas P.Hentschell,Leslie A.Parks,Brad Roberts,and Joanne Reinkensmeyer of the City of Tacoma ,State of Washington ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Compa,2ave caused this instrument to be signed and their corporate seals to be hereto affixed,this 15th day of , G6 . Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company �,,y St.Paul Guardian Insurance Company . GASu, W`•TY �_. ".••',. F1i•,.•• \�N..I,yS �NS�"M. J,,�tV ANpm ♦pp�R jfy 00,S�YMp ? ji. c�°0g4p G c i`%4 ,k•• •.9 J .q•'• 0 4 e :) ♦ pC 19 7�r � 1`� 4. .ys c�'� o••`•...... a�l� d. ..:,, >,. ur i+ 1 `j a State of Connecticut By: Al City of Hartford ss. Robert L.Raney, enior Vice President 15th July 2015 On this the day of , ,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. p,TET In Witness Whereof,I hereunto set my hand and official seal. 'lA RC ' My Commission expires the 30th day of June,2016. * Pusoo * . Marie C.Tetreault,Notary Public w' 491 arP 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked. lop rTh IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this U day of/140Ve/'1(bG / ,20 I ,49 les, ( . Kevin E.Hughes,Assistant Sec tary GASU,�( 0<111"7:*"; S�yGy t•c+�A���D > joaw 9�`� °z`MC1ON9Po5GFW ' 1'`a dizmR�:�'%jc�•vDa-A.Tf�',l�oS �r HARTFORD, '71 < a� � C � CY F� 8901E *; �. ' 4hps t08114 �T 03p°•O46` 1982 0 197EALeo1 occaPCNOMN 1� / � D 'Naf .. . , dy +s r r „vr 14'0AIN • , i To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER A�� ® CERTIFICATE OF LIABILITY INSURANCE DATE 11�7�20`6) THIS CERTIFICATE IS ISSUED AS A MATTER OF I • ri ; . s ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR :):t v.0 LY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE D I ES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICIA IMPORTANT: If the certificate holder is an ADDITII ``L IRS RED,the polic (ies)must be endorsed. If SUBROGATION IS WAIVED, subject to a\g the terms and conditions of the policy,certain policies may require ment. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). C jN��OZ PRODUCER CONTACT Sue Martin HENTSCHELL & ASSOC INC E �7 PHHCNio.Exq A (253)272-1151 X.Noh(253)272-1225 1436 S. Union Ave. LITASS:suem@hentschell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC# Tacoma WA 98405-1925 INSURERA:The Traveler's Indemnity Co. 25658 INSURED INSURERa:Travelers Prop Cas Co of America Petersen Brothers, Inc. INSURER C:Great American Insurance Company 2008 East Valley Hwy INSURER D: I���,�� INSURER E: O V(f'1 —� ,_a Sumner WA 98390 INSURERF: • COVERAGES CERTIFICATE NUMBER:2016 GL AU UM EX 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 SUER POLICY EFF POLICY EXP/N LTR SD WVD POLICY NUMBER IMMIDD/YYYY1 IMM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 V A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 000, 300 PREMISES(Ea Occurrence) $ _ X Y DT-CO-526D9518-IND-16 11/1/2016 11/1/2017 MED EXP(Any one person) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 1/ POLICY X izei LOC I PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER: j $ AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ^ SCHEDULED id P BODILY 1 -810-526D9519-IND- 6 11/1/2016 11/1/2017 (Per $ AUTOS AUTOS DT ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS 8 AUTOS (Per accident) $ $ B X UMBRELLALIAB X OCCUR DTSM-CUP-52609518-TIL-16 11/1/2016 11/1/2017 EACH OCCURRENCE $ 1,000,000_ '''./ C x EXCESSLIAB CLAIMS MADE $10,000 Retention AGGREGATE $ 1,000,000 DED X RETENTION$ Travelers TUE0196246-06 (Excess) 11/1/2016 11/1/2017 Each Occurrence/Aggregate $ 5,000,000 )1110(14366XISMO ACKOW PER OTH- (EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory In NH) DT-CO-526D9518-IND-16 11/1/2016 11/1/2017 E.L.DISEASE-EA EMPLOYEE,$ 1,000,000 DESCRIPTIONIf Edescribe under Gap) E.L.DISEASE-POLICY LIMIT $ 2,000,000 OF OPERATIONS below (WA-Stop DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: #4273-Tracyton Beach Rd Guardrail Blanket Additional Insureds - Primary and Non-Contributory basis as required by written contract or agreement per the attached Endorsement #CGD246. Blanket Waiver of Subrogation as required by written contract or agreement per the attached Endorsement #CGD316. CERTIFICATE HOLDER CANCELLATION (360)478-5200 Katie.ketterer@ci.bremerto SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF BREMERTON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RISK MANAGEMENT DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 345 6TH ST #600 BREMERTON, WA 98337 AUTHORIZED REPRESENTATIVE Thomas Hentschell/SLM ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02512014011 4 • COMMERCIAL GENERAL LIABILITY r • THIS ENDORSEMENT CHANGES THE POLICY:rPL.•EASE READ IT CAREFULLY .0).. BLANKET ADD11'f NAL-, INSURED • (CONTRACTORS) "; ..c1f/ This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a °written contract requiring insurance" "property damage' caused by 'your work' to include as an additional insured on this Cover- and included in the °products-completed op- age Part,but: erations hazard' unless the "written contract a) Only with respect to liability for"bodily injury°, requiring insurance° specifically requires you °property damage"or"personal injury"; and to provide such coverage for that additional b) If, and only to the extent that, the injury or insured, and then the insurance provided.to the additional insured applies only to such damage is caused by acts or omissions of "bodily injury° or °property damage' that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the 'written contract requiring insur- requiring insurance" applies. The person or ance' requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 2. The insurance provided to the additional insured 3. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the 'written contract requiring insurance°, the in- °written contract requiring insurance° specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired' by that °written contract requiring in- this insurance is primary to 'other insurance' surance'. This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance'. But the insurance provided to sured does not apply "both injury", the additional insured by this endorsement still is pp y yry ' prop- excess over any valid and collectible "other in- erty damage or personal injury' arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on'any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying'services, including: an additional insured under such 'other insur- I. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage-,provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured,must give us written prove,drawings and specifications; and notice as soon as practicable of an "occur- il. Supervisory, inspection, architectural or. rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice should include: CG D2 46 08 OS ©2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 / I - COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence' any provider of"other insurance'which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence" or ante° available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit° is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS: claim or"suit°and the date received; and °Written contract requiring insurance" means Ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or °suit" as person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the "bodily injury" and "property damage°oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit°, and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect;and fense and indemnity of any claim or °suit° to c. Before the end of the policy period. • Page 2 of 2 ©2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part,and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only.Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and therest of your policy carefully to determine rights,duties,and what is and is not covered. A. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased B. Damage To Premises Rented To You Equipment C. Increased Supplementary Payments I. Blanket Additional Insured — States Or Political D. Incidental Medical Malpractice Subdivisions—Permits E. Who Is An Insured— Newly Acquired Or Formed J. Knowledge And Notice Of Occurrence Or Offense Organizations K. Unintentional Omission F. Who Is An Insured— Broadened Named Insured L. Blanket Waiver Of Subrogation —Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT ABILITY: The following is added to Exclusion g., Aircraft, Exclusions c. and g.through n. do not apply Auto Or Watercraft, in Paragraph 2.of SECTION to 'premises damage". Exclusion f.(1)(a) I —COVERAGES — COVERAGE A BODILY IN- does not apply to"premises damage"caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (a) Chartered with a pilot to any insured; c. Lightning; (b) Not owned by any insured;and d. Smoke resulting from such fire,explosion, (c) Not being used to carry any person or prop- or lightning;or erty for a charge. e. Water; B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f.of Section I—Coverage A 1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion—All Pollu- COVERAGE A BODILY INJURY AND don Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. elusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — UMITS OF IN- SURANCE. CG D3 1611 11 0 2011 The Travelers Indemnity Company.All rights reserved. Page 1 of 6 , • • L, COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC.. C. INCREASED SUPPLEMENTARY PAYMENTS TION III—LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER- pay under Coverage A for damages because AGE: of "premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You Limit will apply to all "property damage" required because of accidents or traffic proximately caused the samerty "occur- law violations arising out of the use of any rence", whether such damage results from: vehicle to which the Bodily Injury Liability fire;explosion;lightning; smoke resulting from Coverage applies. We do not have to fur- suchfire, explosion,.or_.lightning;_or-water;-or Wish these bonds. any combination of any of these causes. 2. The following replaces Paragraph 1.d. of The Damage To Premises Rented To You SUPPLEMENTARY PAYMENTS — COVER- Limit will be: AGES A AND B of SECTION I — COVER- AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the ' Declarations of this Coverage Part;or insured at our request to assist us in the investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part. D. INCIDENTAL MEDICAL MALPRACTICE 4. The following replaces Paragraph a. of the definition of"insured contract" in the DEFINI- 1. The following is added to the definition of"oc- TIONS Section: currents"in the DEFINITIONS Section: a. A contract for a lease of premises. How- "Occurrence" also means an act or omission committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any person or organization for Good Samaritan services"to a person. "premises damage"is not an"insured contract'; 2. The following is added to Paragraph 2.a.(1)of 5. The following is added to the DEFINITIONS SECTION ll—WHO IS AN INSURED: Section: Paragraph (1)(d) above does not apply to "Premises damage" means "property dam "bodily injury" arising out of providing or fail- age"to: ing to provide: a. Any premises while rented to you or tern- (I) "Incidental medical services" by any of porarily occupied by you with permission your "employees" who is a nurse practi- of the owner;or tioner, registered nurse, licensed practical b. The contents of any premises while such nurse, nurse assistant, emergency medi- calpremises is rented to you, if you rent such technician or paramedic;or premises for a period of seven or fewer (Ii) First aid or"Good Samaritan services"by consecutive days. any of your "employees" or "volunteer 6. The following replaces Paragraph 4.b.(1)(b) workers", other than an employed or vol- of SECTION IV— COMMERCIAL GENERAL unteer doctor. Any such "employees" or LIABILITY CONDITIONS: "volunteer workers" providing or failing to (b) That is insurance for"premises dame a"; provide first aid or"Good Samaritan ser- ge"; vices"during their work hours for you will or be deemed to be acting within the scope T. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 4 2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 6. of 4. Any organization you newly acquire or form, SECTION III—LIMITS OF INSURANCE:. other than a partnership,joint venture or lirn- or the purposes of determining the appiica- ited liability company, of which you are the bile Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- . omissions committed in providing or failing to jority ownership interest, will qualify as a provide"incidental medical services", first aid Named Insured if there is no other insurance or"Good Samaritan services"to any one per- which provides similar coverage to that or- son will be deemed to be one"occurrence". ganization. However. 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I —COV- only: ERAGES—COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (1) Until the 180th day after you acquire or form the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it;or cels committed by, or with the knowledge or (2) Until.the end of the policy period, when consent of,the insured. that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means: within 180 days after you acquire or form a. Medical,surgical, dental, laboratory,x-ray it, and we agree in writing that it will con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages;or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization;and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received. formed the organization. . 6. The,following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED—BROADENED NAMED cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- TIONS: The following is added to SECTION II—WHO IS The.'insurance is excess over any valid and AN INSURED: collectible other insurance available to the in- My of your subsidiaries,other than a partnership, sured,whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declare- your',"employees" or "volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. vices", first aid or"Good Samaritan services" No such subsidiary is an insured for"bodily injury" to any person to the extent not subject to or"property damage" that occurred, or"personal Paragraph 2.a.(1) of Section II — Who Is An injury" or "advertising injury" caused by an of- Insured. fense committed after the date, if any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50%in such sub- The following replaces Paragraph 4. of SECTION sidiary. II—WHO iS AN INSURED: CG D3 16 11 11 02011 The Travelers Indemnity Company.All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED-OWNERS, H. BLANKET ADDITIONAL INSURED-LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II -WHO IS The following is added to SECTION II- WHO IS AN INSURED: AN INSURED: Any person or organization that Is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- clude as an additional insured on this Coverage tract or agreement to include as an insured on re- Part is an insured,but only with respect to liability this Coverage Part is an insured, but only with"bodily injury", "properly damage", "personal spect to liability for "bodily injury", "propertydam- for injury" g age","personal injury"or"advertising injur "that: injury"or"advertisingin'u 'that: a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising occurs, is "personal injury"or "advertising injury" caused by an offense that is commit injury" caused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement;and tract or agreement; and b. Is caused, in whole or in part, by your acts or b. Arises out of the ownership, maintenance or use of that part of any premises leased to omissions in the maintenance, operation or you. use of equipment leased to you by such equipment lessor. The insurance provided to such premises owner, manager or lessor is subject to the following pro- The insurance provided to such equipment lessor visions: is subject toof the following provisions: a. The limits of insurance provided to such a. The limits of insurance provided to such premises owner, manager or lessor will be equipment lessor will be the minimum limits the minimum limits which you agreed to pro- which you agreed to provide In the written vide in the written contract or agreement, or contract or agreement, or the limits shown on the limits shown on the Declarations, which- the Declarations,whichever are less. ever are less. b. The insurance provided to such equipment b. The insurance provided to such premises lessor does not apply to any"bodily injury"or owner, manager or lessor does not apply to: "property damage" that occurs, or "personal injury"or"advertising Injury"caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs, or"personal injury"or"adver- lease expires. tieing injury"caused by an offense that is committed, after you cease to be a tenant c. The insurance provided to such equipment in that premises;or lessor is excess over any valid and collectible other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED - STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS-PERMITS the written contract or agreement that this in- surance must be primary to, or non- The following is added to SECTION tl-WHO IS contributory with, such other Insurance, in AN INSURED: which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 C 2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include as an additional insured on this Coverage company;Part is (ii) A managerof any limited liability or an insured, but only with respect to liability for "bodily injury, "property damage", "personal in- (iii)any AnenY othereorganization officer or director of jury"or"advertising injury"arising out of such op- organization; erations. that is your partner, joint venture The insurance provided to such state or political member or manager;or subdivision does not apply to: (b) Any "employee" authorized by such partnership, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury' or"advertising injury"arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. lineal subdivision; or b. .Any 'bodily injury" or "propertydamage" in- Notice to us of such "occurrence"or of an Y in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us The following is added to Paragraph 2., Duties In of the"occurrence"or offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit, of SECTION IV — COMMERCIAL GEN- scnbed in Paragraphs e. (1) or(2) above ERAL LIABILITY CONDITIONS: discovers that the"occurrence"or offense e. The following provisions apply to Paragraph may result in sums to which the insurance a. above, but only for the purposes of the in- • provided under this Coverage Part may surance provided under this Coverage Part to apply' you,or any insured listed in Paragraph 1. or 2. However, if this Coverage Part includes an en- of Section II—Who Is An Insured: dorsement that provides limited coverage for (1) Notice to us of such "occurrence" or of- "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- Tense must be given as soon as practica- ble only after the "occurrence"or offense cape's"pollutants"which contains a requirement that the discharge, release or escape of "pollut- is known by you(if you are an individual), any of your partners or members who is ants" must be reported to us within a specific number of days after its abrupt commencement, in individual (if you are a partnership or joint venture), any of your managers who, this Paragraph e. does not affect that require- is an individual (if you are a limited liability meet. company), any of your "executive offi- K. UNINTENTIONAL OMISSION cers" or directors (if you are an organize- The following is added to Paragraph 6., Repre- tion other than a partnership,joint venture sentatlons, of SECTION IV — COMMERCIAL or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS: ployee" authorized by you to give notice The unintentional omission of, or unintentional of an"occurrence"or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company,and none of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence"or offense must be given es cancellation or nonrenewal in accordance with soon,as practicable only after the "occur- • applicable insurance laws or regulations. rence or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8.,Transfer (I) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nershlp or joint venture; of SECTION IV— COMMERCIAL GENERAL LI- ABILITY CONDITIONS: • CG D3 16 11 111 0 2011 The Travelers Indemnity Company.All rights reserved. Page 6 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury,shock,fright, disability, against any penton or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organize- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Paragraph c. of the b. "Personal injury" or "advertising injury" definition of"insured contract"in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of.-"insured M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- The following replaces the definition of "bodily leied. injury"in the DEFINITIONS Section: Page 6 of 6 0 2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 • • 1 ACO DATE(MM/DD/YYYY) n CERTIFICATE OF LIABILITY INSURANCE 01/09/2016 THIS CEIITIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kent Hamilton PHONE I FAX Front Row Insurance Brokers, LLC. (A/C,No,Ext): 424-529-6700 (A/C,No): 424-529-67013 14156 Magnolia Blvd,Suite 200 E-MAIL ADDRESS: kent@frontrowinsurance.com Sherman Oaks, CA. 91423 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hiscox Insurance Company,Inc 10200 XVIII Entertainment LLC INSURER B: State National Insurance Company,Inc 12831 1619 S.Victory Blvd. INSURER C: Glendale,CA,91201 INSURER D: ( '— INSURER E: COVERAGES 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 MAYBE 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. INS ADDL SUBR POLICY POLICY EFF POLICY EXP R TYPE OF INSURANCE INSR WVD NUMBERMM/DD/YY) LIMITS LTR (MM/DD/YY) A GENERAL LIABILITY Y N USUEN2 01/15/16 01/15/17 EACH OCCURENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY 717680.1 FIRE DAMAGE(Any one fire) $1,000,000 'X OCCUR 6 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PROJECT LOC A AUTOMOBILE LIABILITY Y N USUEN2 01/15/16 01/15/17 COMBINED SINGLE LIMIT $1,000,000 717680.1 (Ea accident) ANY AUTO 6 BODILY INJURY(Per Person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per Accident) X HIRED AUTOS X NON OWNED PROPERTY DAMAGE(Per accident) AUTOS AGG $ A COMMERCIAL UMBRELLA Y N USUEN27 01/15/16 01/15/17 EACH OCCURENCE $1,000,000 1768016 GENERAL AGGREGATE $1,000,000 B WORKERS'COMPENSATION N HSW271 01/15/16 01/15/17 X WCSTATUT- OTHER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 3914.16 ORY LIMITS OFFICE/MEMBER EXCLUDED? Y E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A ENTERTAINMENT PACKAGE n/a N USUEN2 01/15/16 01/15/17 Miscellaneous Equipment $1,000,000 Limit 717680.1 $3,500 Ded. 6 $1,000,000 Limit Props,Sets&Wardrobe $3,000 Ded, 3rd Party Property Damage $1,000,000 Limit $2,500 Ded. $1,000,000 Limit Hired Auto Physical Damage Ded: 10%of loss, $2,500 min/ $7,500 max DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: The certificate holder is included as additional insured and/or loss payee as their interest may appear,but only as respects Liability arising out of the operations of the named insured. Excludes filming exposures related to stunts and hazardous activities,unless declared and approved. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE CITY OF B RE M E RTO N ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE Attn: Risk Mana ement HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO ONBLIGATION OR g LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES 345 6th Street Suite 600 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD