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HomeMy WebLinkAbout5711PUBLIC WORKS AGREEMENT THIS AGREEMENT, is entered into between the City of Bremerton, a Washington Municipal Corporation ("City"), and PlgyCreation, Inc. ("Contractor"), whose mailing address is ® 2464 SW 152nd Street, Suite 1, Burien, WA 98166. The parties agree as follows: 1. CONTRACTOR SERVICES. The Contractor shall perform the following services for the City: • Layout, mark, and dig all holes required for play equipment • Set main posts in concrete. 2. TIME OF COMPLETION. Contractor shall complete the work by August 311t, 2017 3. COMPENSATION. The City shall pay the Contractor the total amount of $3,978.50, plus any applicable Washington State Sales Tax, for the work and services contemplated in this agreement. The City shall pay the Contractor fifty percent (50%) of the Contract amount upon completion and acceptance of the work by the City, and the remainder upon fulfillment of the conditions listed below and throughout this agreement. A. No Performance Bond. Because this contract, including applicable sales tax, is less than $25,000, and pursuant to Chapter 39.08 RCW, the Contractor, in lieu of providing the City a performance bond, has elected to have the owner retain the final fifty percent (50%) of the Contract amount 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. 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. PUBLIC WORKS AGREEMENT - Page 1 of 8 (between City of Bremerton and PlayCreation, Inc.) 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 fin-ther monies due under this agreement until the Contract work is completed. 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 to this agreement and can also be found by visiting the following link to the State of Washington web site: bft://ini.wa.gov/TradesLicensing/PrevWa eg /War4eRates/ 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 oto the City; 2. Supplement the written protest within fourteen (14) calendar days with a written statement that provides the following information: PUBLIC WORKS AGREEMENT — Page 2 of 8 (between City oj'Bremerton and P1ayCreation, Inc.) 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. 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 Dutyto o 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 PUBLIC WORKS AGREEMENT— Page 3 of 8 (between City` of Bremerton and PlayCreation, Inc.) 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. 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 sole 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 against claims for injuries to persons or damage to property that may arise PUBLIC WORKS AGREEMENT -- Page 4 of 8 (between City of Bremerton and PlayCreation, Inc.) from; or in connection with the performance of the Contract work by the Contractor, its agents, representatives, employees or subcontractors. Before beginning the work on the project described in this agreement, the Contractor shall provide a Certificate of Insurance evidencing: A. Automobile Liability insurance with limits no less than 9i 1,000,000 combined single limit per accident for bodily injury and property damage; and B. Commercial General Liability insurance written on an occurrence basis with limits no less than $1,000,000 combined single limit per occurrence and $2,000,000 aggregate for personal injury, bodily injury and property damage. Coverage shall include but not be limited to: blanket contractual; products/completed operations/broad from property damage; explosion, collapse and underground (XCU) if applicable; and employer's liability. 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 6h 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 PUBLIC WORKS AGRF.,EMENT — Page 5 of 8 (between City of Bremerton and P4Creation, Inc.) 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 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. PUBLIC WORKS AGREEMENT — Page 6 of 8 (between City of Bremerton and I'IayCreation, Inc.) 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. IN WITNESS WHEREOF, the parties below have executed this agreement. CO 'RACTOR Pr in a_me: -IOH W ►Nt,tf4.t.�tc�- Title:a� 1 t)C—rt - i - DATE 2 0 -tc l Notices to be sent to: CONTRACTOR: John Larson PlayCreation, Inc. 2104 SW 152nd Street, Ste. 1 Burien, WA 98166 iohnlolaycreation coni (206) 932-5778 R;iLEGAL1Comracts\FORI,15�ShortForm,PW.Agr.doc PUBLIC WORKS AGREEMENT—Page 7 of (between City ofBremeton and P14yCre4ti0n, Inc.) THE CATY OF BRE MERTON Print Name: Jefflevado Title: Parks and Recreation Director / DATE r;4 I�?�1� Notices, to be sent to: CITY OF BREMER.TON: Colette Berna Parks & Recreation Department 680 Lebo Blvd. Bremerton, WA 98310 colette.berna(u;c, .i bremegon.Wa.us (360)473-5429 APPROVED AS TO FORM: BremertonAtl:ornc4,t7 y ATFiST: Bremerton City Clerk 7/21/2017 abouttlank State of Washington Department of Labor & Industries Prevailing Wage Section - Telephone 360-902-5335 PO Box 44540, Olympia, WA 98504-4540 Washington State Prevailing Wage The PREVAILING WAGES listed here include both the hourly wage rate and the hourly rate of fringe benefits. On public works projects, worker's wage and benefit rates must add to not less than this total. A brief description of overtime calculation requirements are provided on the Benefit Code Key. Journey Level Prevailing Wage Rates for the Effective Date: 7/21/2017 County Trade Job Classification Wa a Holiday Overtime Note Kitsap Playground Ft Park Equipment Installers Journey Level $11.00 1 abouttlank 1/1 Certification of Compliance with Wage Payment Statutes The bidder hereby certifies that, within the three-year period immediately preceding the bid solicitation date 05/24/2017, the bidder is not a "willful" violator, as defined in RCW 49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a final and binding citation and notice of assessment issued by the Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. PlayCreation, Inc Bid s Busines Name �i Sigifa7ure of Authorized Official* John Mullan Printed Name President Title 08/01/2017 Date Check One: Burien City Sole Proprietorship ❑ Partnership Joint Venture ❑ WA State Corporation X State of Incorporation, or if not a corporation, State where business entity was formed: S -Corp, WA State, UBI 602 429 413 If a co -partnership, give firm name under which business is transacted: * If a corporation, proposal must be executed in the corporate name by the president or vice-president (or any other corporate officer accompanied by evidence of authority to sign). If a co -partnership,. Proposal must be executed by a partner. ACR©® A".. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYYI 07/07/2017 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 1rHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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 pollcy(les) 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: Lee Insurance Services Inc PHONE FAX A1C No Ext): 1C No): -F 11410 98th Ave NE 6 A ADDRESS: INSURER(S) AFFORDING COVERAGE MAIC # INSURERA: Evanston Insurance Co. t 39020 Krkland WA 98033-439 INSURED INSURERB : National Union Fire Ins CQ A 19445 Play -Creation Inc. INSURER C: c/o John Mullan INSURERD: 2104 SW 152nd St, Unit 1 INSURERE : Burien WA 98166 1 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AWL I N S D HPOLICY WV D POLICY NUMBER EFF MMIDDNYYY POLICY EXP MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXOCCUR EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 A X X 3AA127021 02/17/2017 02/17/2018 GEN'LAGGREGATE LIMITAPPLIES PER: X POLICY ❑ PRO- [:]JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Peracadent $ ( ) NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE $ f'eracddent B A x UMBRELLA LIAB EXCESS LIAB x OCCUR CLAIMS -MADE NIA BE096059307 3AA127021 02/17/2017 02/17/2017 02/17/2018 02/17/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I X I RETENTION $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE 2 OFFICER/MEMBER EXCLUDED? (Mandatory in under If yes, describe under $ PER OTH- STATUTE x ER STOP GAP E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 11000,000 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OFOPERATIONS below -F I I DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Bremerton, employees, agents and volunteers are named as additional insured's per form MEGL 009-01 (05/16) and CG2001 (04/13). Waiver of subrogation applies,per form MEGL 0241-01 (05/16 City of Bremerton Attn: Risk Management 345 6th St, Suite 600 Bremerton ACORD 25 (2014/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WA 98337 v -lauu-cU14NCORU CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY FOLIGY NUM8ER-, 3AA127021 mmm ■ EVANSI ON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOTEKI AGAINST OTHERS TO US This endorsement modifies Frisurance proVided under the foilowing; COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any persons) ororgaeizatiton(s) vy'llh whom the Named Insured agrees, in a written contract executed prior to the 1'occurrenW to w alve, rights of recovery Additional Premium: $ Inc_ luded The following is added to Condition 8. Transfer Of Rights bf Recovery Against Others To Us under Section IV — Cornmereial General Lialbility. Conditions: We waive- any right of recovery we may have against Any person, or organiza0m s4own in the, Schedut'.e of this enidoIrsernent, This waiver npl6g only, to: the. person . or organization shown In'the Schedule of this endorsement. Ail other terms and ond'it! . ons rerhain unchanged. A of insurance Services Office, Inc., page 1 ofA MEGL 0241-01 D516 Includes copyrighted material with b. permissim. COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 © Insurance Services Office. Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIIA81LITY POLICY NUMBER- .EVANSTON INSURANCE COMPANY THIS- ENDOREMENT CHANGES THE PO,UCY: PLEASE READ IT CAREFULLY. BLANKET ADINTIONAL INSUREV This endorsement -modifies insurano. provided birder the fc lowing; COMMERCIAL GENERAL LIABILITY GO.VERA FORM LIEtll LiAljL1TY tVERAGE FORM OWNERS AND CONTRACTbRS PROTECTIVE LIABILITy.CoVEERAGE FORM F'RQ0Ud-TS/C'QMP' LETEI OPEF TI'QNS LIABILITY COVER_ A' bEF{'_ SCHEDULE Additional Premium:. $ Included (Check box iffullyearned.n A. Who Is An Insured is amended to include as an additional insured any person or entity to whom you are obligated by valid written contract 16 provide such coverage, but only with respedt to: negligent acts or omi§sions of the Named Insured and only with respect. to any coverage not 6therwise. excluded in the p6l:icy. However: 1. The insurance afforded to such additional insured, only applies o. the extent permitted bylaw; and 2 if .cdverage provided to the ;additional insured Is requiriod by a. �qntract to s4ph 001:10nal insured will not he t r prier than thatL which you are. required by th6 contract or agroom nitto provide far such additional insured. QiaP a rpara rtt to acpeot-An additFonat n oradprtivi ii r in a:contract iS, net err a eptanoe. f any Q.ther provisi€tr7s 1 the edntract.or IhO n ct in t0taj, When otiveraga do.s not. apply for the Named fistsured, no cowerage:ordeferisewill apply for the arfdikidiil ariUtcrr: No coverago. applies tis the. add*tionA Insured shown in the 96hedule of this endorsee lent for injury or damage. of any pe to any �amplcyee" of the Narne[I Insured or t4 arty obllgativn of the additional insured to indernnjfy another because of darnages a6kinq: out of such injury or darhage: 86 With respect ko.the l isuranco:aff0fded.to these additional Insured, the following is added to limits of insuraric If coverage provided to the additional insured 'is required. by a: contract or agreement= tate most we will pay on behalf. of the additional i'nsr red is the'amount of:rnsurance: 1. Required by the contract or agreernent or 2. Atraiiable under the applicable limits of InsurariM shewn:in the Nclaratidns; whlch�ever i less, This endorserleritshall n in reale the appikea ale li its 0 insuranceshown n in the CrecBaeationst All ether teriiis and conditions rem-'sh uni<hanged. M'EGL 0009-0'1 OS 16 Includes copyrighted material of Insurance Services office, Inc., Page t of i with its permission. PI AVr_1 no,irl• ca CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDffYr ) 07/07/2017 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER 425-576-0464 Lee Insurance Services, Inc. 11410 98th Avenue Northeast _ CONT Sandie Brase PHONE FAX A/C, No, Ext): 425-576-0464 A/C No): 425-576-1915 E-MAIL sandieb@lee-insurance.com ADORES Kirkland, WA 98033-4325 Lee Insurance Services, Inc. 345 6th St. Suite 600 Bremerton, WA 98337��A� AUTHORIZED REPRESENTATIVE �✓ INSURERS AFFORDING COVERAGE NAI: # INSURER A: Ohio Security Insurance X 24082 MED EXP (Any oneperson)_ INSURED Play -Creation Inc. John Mullan 2104 SW 152nd St, Unit 1 INSURER B: INSURER C : — GENERAL AGGREGATE _ Burien, WA 98166-2064 INSURER D: INSURER E: AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED r NON -OWNED AUTOS ONLY AUTOS ONLY INSURER F: X rOVFRAGFS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR LTR TYPE OF INSURANCE DDL INSD UBR WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMITS — ACCORDANCE WITH THE POLICY PROVISIONS. COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR Attn: Risk Management 345 6th St. Suite 600 Bremerton, WA 98337��A� AUTHORIZED REPRESENTATIVE �✓ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISS (Ea n $ — MED EXP (Any oneperson)_ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE _ PRODUCTS - COMP/OP AGG _ $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED r NON -OWNED AUTOS ONLY AUTOS ONLY X X BAS57449708 11/03/2016 11/03/2017 EO aBINEeD SINGLE LIMIT $ 1,00o,000 BODILY INJURY Perperson) $ BODILY INJURY Per accident _ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE _ AGGREGATE DED I I RETENTION $ $ — WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVEEl OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- TATU E E.L. EACH ACCIDENT _ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ _ �CRIT NOF OP RATIONS / OCATIONS I VEHI LES AOR 101 Additional Remarks Sc edule a .be alta ed if more space is required) IFfSy o Bremer on, employees, agents al�c�vo°luhteers are name $�C�ILlona� insured's as respects their interest In operations of insured where required by written contract per attached CA8810 0110 endorsement r-ANrl:l I ATInN Ut:K I Ir 1%,A I r- MUl_UMM -- — — CITYBRE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton Attn: Risk Management 345 6th St. Suite 600 Bremerton, WA 98337��A� AUTHORIZED REPRESENTATIVE �✓ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORAT IUN. Au rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CA 88 10 01 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO. COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement.. COVERAGEINDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 18 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 21 EMPLOYEES AS INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 22 EXTRA EXPENSE -BROADENED COVERAGE 10 GLASS REPAIR - WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN / LEASE GAP 14 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT g SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 19 SECTION II - LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II, - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following, as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any or(J anization that: (1) Is a partnership or joint venture; or (2fl Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization; ©2010 Liberty Mutual Insurance Company. All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 1 of 7 b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $750 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V - DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have'a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 02010 Liberty Mutual Insurance Company. All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 3 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, Jf the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto'; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN / LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", L Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V - DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. ©2010 Liberty Mutual Insurance Company. All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 5 of 7 a 20. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended, by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V - DEFINITIONS is amended as follows: 21. BODILY INJURY REDEFINED Under SECTION V - DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 22. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. CA 88 10 01 10 Ini