HomeMy WebLinkAboutFoggle Pump & Supply Inc - Farm Well #3 Cleaning and Rehabilitation (Agreement No. 21-008) and Change OrderMemo q1I
To: Project File
From: Derek Wiitala, Public Works Division Manager
Date: 03-11-2021
Re: Unanticipated work addition
Pasco
This memo is to provide for addition unexpected work to be completed on the project: Farm Well #3
Cleaning and Rehabilitation; Project #21-008.
The Contractor has been removing an unexpected appreciable amount of material from this well. The
additional work is estimated to take two (2) extra days. The additional cost of this work has been identified
at $250.00 as indicated in the attached hourly breakdown. The total cost of the additional work is
estimated at $7,560. The undersigned has authorized this work to be completed.
Submitted by, k&- "I Date 3 /Z Zdz
Tom Holmes, Public Works Division Manager
CONTRACT
MRSC SMALL WORKS ROSTER
Farm Well #3 Cleaning and Rehabilitation
Agreement No. 21-008
THIS CONTRACT is made and entered into this day of 2021, by
and between the City of Pasco, Washington, a Municipal Corporation, hareinaf%referred to as
"City", and Fogle Pump and Supply Inc., hereinafter referred to as "Contractor."
WHEREAS, the Project qualifies under RCW 39.04.155 as a small works roster contract,
or a limited public works contract; and
VMRF`AS, the City having sought and secured quotations from its small works roster,
and the Contractor being duly qualified as a Contractor on the small works roster having submitted
a quotation moble to the City.
NOW, THEREFORE, in consideration of the mutual covenants contained herein, the
parties agree as follows:
1. Descr3n0bn of Work. The Contractor shall furnish all equipment, labor, tools, materials
and appurtenances and perform all services in a workmanlike manner and in accordance
with the plans and specifications as provided in the Project Description and Specifications,
attached hereto as Exhibit A.
2. Comrsensatian. Compensation for the performance of the service and materials as
described in Exhibit A, and shall be:
M That amount set in the quotation attached hereto as Exhibit B subject to any retainage
or withholdings as provided below.
3. Time of Comoletion. The work coved by this Contract shall be completed with all
respects within 60calendar days from the date of the Notice to Proceed.. Once the work is
commenced, the Contractor shall diligently pursue the work to completion within the time
specified in this Contract.
4. Warranty of Cont-aetor. Contractor warrants that it is qualified to be awarded a public
works contract in compliance with RCW 39.04.350; and further agrees to comply with all
State and Federal laws relating to the employment and wage rates to be paid.
5. IndenmUlcation.
5.1 The Contractor shall defend, indemnify, and hold harmless the City, its officers,
officials, agents, employees, and volunteers from any and all claims and causes of
action, including, but not limited to, actions of law or administrative proceedings
for all injuries to persons or damages to property, and all losses, damages, demands,
Farm Well #3 Cleaning and Rehabilitation — 21-008 Page 1
MRSC Small Works Roster Amt#: [21-008] — Fogle Pump and Supply Inc
suits, judgments, including attorney fees, arising out ol; or as a result of, or in
connection with the work performed udder this Agreement, and caused or
occasioned in whole or in part by reason: of mors, negligent acts or omissions of
the Consultant or its subcontractors in the performance of this Agreement, except
for injuries and damages caused by the sole negligence of the City, its officers,
employees, agents, and volunteers.
5.2 Should a Court of competent jurisdiction d -W=e that this Agreement is subject
to RCW 424, 115, then, in the event of liability for damages arising out of bodily
injuries or damages to property caused by or resulting from the concurrent
negligence of the Contractor, and the City, its officers, employees, agents and
volunteers, the Contractor's liability and obligation to defend hereunder shall only
be the proportionate extent of the Contractor's negligence.
5.3 It is further agreed that the indemnification provided herein constitutes the
Contractor's waiver of immunity under Industrial Insurance, Title 51 RCW, solely
for the purposes of this indemnification.
5.4 No liability shall attach to the City by reason of entering into this Agreement except
as expressly provided herein.
5.5 This indemnification shall include damages, penalties and attorney fees agained
as a result of Contractor's delayed or failed performance.
5.6 This waiver has been mutually negotiated by the parties, and the provisions of this
section shall survive the expiration or termination of this Agreement.
6. insurance. The Contractor shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which may arise
from or in connection with the performance of the work hereunder by the Contractor, its
agents, representatives, employees, or subcontractors.
6.1 Minimum Scone of Insimmee. Contractor shall obtain insurance of the types
described below:
61.1 Automobile Liability insurance covering all owned, non -awned, hired and
leased vehicles. Coverage shall be written on Insurance Services Office
(ISO) form CA 00 01 or a substitute form providing equivalent liability
coverage. If necessary, the policy shall be endorsed to provide contractual
liability coverage.
6.1.2 Commercial General Liability insurance shall be written on ISO occurrence
form CG 00 01 and shall cover liability arising from premises, operations,
independent contractors and personal injury and advertising injury. The
City shall be named as an insured under the Contractor's Commercial
General Liability insurance policy with respect to the work performed for
Farm Well #3 Cleaning and Rehabilitation — 21-008 Page 2
NIBSC Small works Roster Agreement#: [21-008] — Fogle Pump and supply Inc
the City using an additional insured endorsement at least as broad as ISO
endorsement form CG 20 26.
6.1.3 Workers' Compensation coverage as required by the Industrial Insurance
laws of the State of Washington.
6.1.4 Professional Liability insurance appropriate to the Contractor's profession.
6.2 Minimum Amounts of Insurance. Contractor shall maintain the following
insurance limits:
6.2.1 Automobile Liability insurance with a minimum combined single limit for
fly injury and property damage of $1,400,000 per accident.
6.2.2 Commercial General Liability insurance shall be written with limits no less
than:
❑ $1,000,000 each occurrence;
® $2,000,000 general aggregate; or
❑ $ each occurrence; and $ general aggregate
6.2.3 Professional Liability insurance shall be written with limits no less than:
❑ $1,000,000 per claim;
® $1,000,400 policy aggregate limit; or
❑ $ per claim; and $ per policy aggregate limit
6.3 Other Insurance Provisions. The insurance policies are to contain, or be endorsed
to contain, the following provisions for Automobile Liability and Commercial
General Liability insurance:
6.3.1 The Contractor's insurance coverage shall be primary insurance as respects
the City. Any insurance, self-insurance, or insurance pool coverage
maintained by the City shall be excess of the Contractor's insurance and
shall not contribute with it.
6.3.2 The Contractor's insurance shall be endorsed to state that coverage shall not
be cancelled by either party, except after thirty (30) days prior written notice
by certified mail, return receipt requested, has been given to the City.
6.4 Acceptability of Insurers. Insurance is to placed with insurers with a current A.M.
Best rating of not less than ANII.
6.5 Verification of Coverage. Contractor shall furnish the City with original
certificates and a copy of the amendatory endorsements, including but not
Farm Well #3 Cleaning and Rehabilitation — 21-008 Page 3
MRSC Small Works Roster Agreement#: [21-008] — Fogle Pump and Supply Inc
necessarily limited to the additional insured endorsement, evidencing the insurance
requirements of the Contractor before commencement of the work.
7. Retainaize and Performance Band.
7.1 Unless it is waived as provided below, the Contractor shall provide and post for the
benefit of the City a Performance and Payment Bond issued by a qualified surety
insuring the Contractor's performance of all the provisions of the Contract and
payment of all labors, mechanics, and subcontractors and materialmen as required
by RCW 39.08.010.
❑ The City shall hold a 10% retainage in lieu of a performance bond per RCW
39.08.010
7.2 The City shall withhold five percent (5%) of the money due to the Contractor for
the work performed under this Contact until completion and/or acceptance of the
Contract as provided by RCW 60.28.011. Contractor may elect an option for
management of the statutory retainage by notice to the City of the elected option
under RCW 60.28.011.
8. W r §ft Conditions. The work performed under this Contract is done at the Contractor's
risk and that Contractor is familiar with the conditions present and other contingencies
likely to affect the work and has submitted their quote accordingly. The Contractor will
assume the responsibility and risk of all loss or damage to materials or work which may
arise prior to completion.
The Contractor shall keep the work site in a neat, orderly condition and after completion
of the work, the Contractor shall, at its expense, clean up and remove all refuse and unused
materials of any kind resulting from the work.
9. General Provisious.
9.1 For the purpose of this Contract, time is of the essence.
9.2 Notice. Notice provided for in this Contract shall be sent by:
9.2.1 Personal service upon the Project Administrators.
9.2.2 Certified mail to the physical address of the parties, or by electronic
transmission to the email addresses designated for the parties below.
9.3 The Project Administrator for the purpose of this Contract shall be:
9.3.1 For the City: Albert Obermiller, or his/her designee
Public Works Project Coordinator
1025 S Gray St.
Farm Well #3 Cleaning and Rehabilitation -21-008 Page 4
MRSC Small Works Roster Agreenent#: [21-0081— Fogle Pump and Supply Inc
Pasco WA 99301
obermille ivi2asco-wa.gov
9.3.2 For the Contractor: Alaina Fogle, or his/her designee
Fogle Pump and Supply Inc.
2250 N. Hwy
Colville, WA 99114
Alaina@foglepump.com
10. Dispute Resoludon. This Contract has been and shall be construed as having been made
and entered into and delivered within the State of Washington, and it is agreed by each
party hereto that this Agreement shall be governed by the laws of the State of Washington.
In the event of a dispute regarding the enforcement, breach, default or, interpretation of
this Contract, said dispute shall be resolved by arbitration pursuant to RCW 7.04A, as
amended, with both parties waiving the right of a jury trial upon trial de novo, with venue
placed in Pasco, Franklin County, Washington. The substantially prevailing party shall be
entitled to its reasonable attorney fees and costs as additional award and judgment against
the other.
IN WITNESS WHEREOF, the parties have executed by their duly authorized official
this Contract in triplicate, each of which being deemed an original on the date first written above.
CITY OF PASCO, WASHINGTON
By:
Zlev"Worley.
CONTRACTOR
By:"00"
b x
Alaina Fogle,Direct r of Operations --
Farm Well #3 Cleaning and Rehabilitation — 21-048 Page 5
MRSC Small Works Roster Agreement#: [21-0081— Fogle Pump and Supply Inc
Schedule A
Farm Well #3 Cleaning and Rehabilitation
March 120'-1701
Move Cable tool, service truck, pump truck and frac unit from Farm Well 2 to Farm Well 3. Use
Cable tool with brush to brush well removing initial layer of scaling. Add liquid descaler
chemical to well using Cable tool to brush and agitate. As acid is consumed by the well, use frac
unit with venturi clean out tool to recirculate water into sediment holding tank and back into
well. Use PH strips to test the PH of the well every 3-4 hours. When PH holds steady at around
2, camera the well and record video. Sanitize the well using Wet -Chlor plus.
EXHIBIT A
Request for Quote
Scope of Work
The quote shall include a description and associated cost for the following line items:
➢ Timeline of work
➢ Mobilization/demobilization
➢ Post—cleaning video inspection
➢ Cleaning method
➢ Treatment
➢ Rehabilitation/re-development
➢ Site cleanup — to include removal of all material removed from the well
➢ Any remediation required, i.e. pH adjustment, sediment disposal, etc.
Information about the Farm well#3
A site visit will be required to bid on this job. The site visit will be held on January 15'h,2021 at 12:00pm.
This work shall not begin until February 15th, 2021, and must be completed by March 31St, 2021.
Information is from inspection completed by the City in December 2020.
• 16" diameter well.
• The year of construction is unknown.
• Depth is 146.4.
• Screen is perforated — roughly 112-149.9'.
• Static water level —101.9'
• Biofouling and incrustation are plugging screens and perforations.
• Video can be found at https://Pascofileshare.com/link/K6fltFKzbgiYmUv9avKlnL
(Instruction for fileshare site located on last page)
General Considerations
• Site Safety - The CONTRACTOR shall mark, barricade or take other safety measures as necessary to
prevent tampering with the work site and to eliminate dangerous conditions for persons or animals in the
area. All tanks, pits, or other excavations shall be properly flagged and barricaded as required to eliminate
any potential health hazards. The CONTRACTOR is expected to maintain the site and any related
equipment and supply storage areas in a clean and orderly manner in order to prevent injury to people and
animals. The CONTRACTOR shall maintain a first aid kit, fire extinguisher, and other safety equipment
required for the work by regulation on site at all times. All work shall be conducted in accordance with
applicable State and Local regulations.
• Noise and Working Hours - The CONTRACTOR shall comply with all applicable laws, orders, and
regulations concerning the prevention, control, and abatement of excessive noise.
Request for Quotes: Farm Well 3 Page 4 of 9
cleaning and rehabilitation
EXHIBIT
• Discharge of Water - The CONTRACTOR shall be responsible for preventing the release of water, or any
other materials used in or related to the rehabilitation operation from the immediate vicinity of the work site
onto neighboring properties or any open water bodies.
Prevention of Contamination
• The CONTRACTOR shall use a minimum of hydrocarbon products, other than fuel, motor oil, hydraulic
oil, and grease that is normally used on site.
• No hydrocarbon -based lubricants or oils shall be used on equipment that will enter the borehole.
• Should any spills occur, the CONTRACTOR shall immediately repair the cause and take the necessary steps
to contain and thoroughly remove all contaminated soils and materials, and transfer such wastes off-site for
legal disposal at the CONTRACTOR'S expense.
Site Access and Preparation
• Access — The well site is located 3.5 miles East of Hwy 395 and .25 miles south of Foster Wells Rd., The
Circle is to the west on the dirt road, the well is 210' east of the center pivot in City Farm Circle #3.
• Services and Supplies — No on-site water or power is available. The CONTRACTOR is responsible for
inquiring about the availability of services and supplies needed for rehabilitation activities. The
CONTRACTOR assumes full responsibility for all supporting services and supplies necessary to properly
undertake the work, not limited to water and power, and is entitled to no additional compensation for the
lack of any such services or supplies.
Request for Quotes: Farm Well 3 Page 5 of 9
cleaning and rehabilitation
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vs�coPUBLIC WORKS OPERATIONS (509)545-3463/FAX (509)545-3466
PO Box 293/1025 S. Gray Ave- Pasco, WA 99301/www.pasco-wa.gov
Quote Price
Item No. Descriatlo nft -d Price
Unit Price Quanft LA_en&
Mobilization/Demobilization Lump Sum
101-1 k
Kj e it bit ta
2 Cleaning Lump Sum I'l 1'1
2a Chemical Y Lbs
(circle e o n e)
2b Cleaning Time Hrs
141,104 Ab
3 FrA �a Rehabilitation Lump Sum
n., 4e
le e)
Hrs
3a Rehab Time :Hrs
Lump
Sum
4 Post work Video Lump Sum
5 Remediation (if applicable) Lump Sum
111-46 'rawl"..e- of
i I M6D
! 6fuCleanup
mp Sum
.— —1 -- The undersigned has reviewed the RFQ and is familiar
with the requirements herein, and has verified the quote Sub Total 6-D
to be true and correct.
Tax Rate (8.096)
Signature Date Total 2,3l2 -I
Request for Quote: Farm Well #2
Cleaning and Rehabilitation Page 6 of 7
PERFORMANCE BOND
BOND TO THE CITY OF PASCO
Bond No. 107368795
KNOW ALL MEN BY THESE PRESENTS:
That we, the undersigned, Fogle Pump & Supply, Inc. as principal, and Travelers Casualty and Surety
Company a corporation organized and existing under the laws of the State of CT, as a surety corporation,
and qualified under the laws of the State of Washington to become surety upon bonds of contractors,
as surety, are jointly and severally held and firmly bound to the City of Pasco in the penal sum of
***Twenty Three Thousand Three Hundred Eighty Two and No/100*** ($23,382.00), for the payment
of which sum on demand we bind ourselves and our successors, heirs, administrators or personal
representatives as the case may be.
This obligation is entered into a pursuance of the statutes of the State of Washington, and ordinances of
the City of Pasco.
Dated at Spokane, Washington, this 18th day of February, 2021.
Nevertheless, the conditions of the above obligation are such that:
WHEREAS, pursuant to action taken by the City Council of the City on , 20_____, the
Mayor and City Clerk of the City of Pasco have let or are about to let to the said Fogle Pump & Supply, Inc.,
the above bounden principal, a certain contract, the same contract being numbered 21-008 and providing
for Farm Well #3 Cleaning and Rehabilitation (which contract is referred to herein and is made a part
hereof as though attached hereto.)
WHEREAS, the said principal has accepted, or is about to accept the said contract, and undertake to
perform the work wherein provided for in the manner and within the time set forth.
NOW, THEREFORE, if the said Fogle Pump & Supply, Inc. shall faithfully perform all of the provisions of
said contract in the manner and within the time therein set forth, or within such extensions of the time
as may be granted under the contract, and shall pay all laborers, mechanics, subcontractors, and material
men, and all persons who shall supply said principal or subcontractors with provisions and supplies for the
carrying on of said work, and shall indemnify and hold said City of Pasco harmless from any loss or damage
occasioned to any person or property by reason of any carelessness or negligence on the part of said
principal, or any subcontractor in the performance of said work, and shall indemnify and hold the City of
Pasco harmless from any damage or expense by reason or failure of performance as specified in said
contract or from defects appearing or developing in the material or workmanship provided or performed
under said contract after its acceptance thereof by the City of Pasco, then and in that event this obligations
shall be void; but otherwise it shall be and remain in full force and effect.
Approved as to Form:
Travelers Casual"d Surety Company Fogle Pump & Supply, Inc.
OI
Surety SheaDonovan, Attorney in Fact Contractor
PAYMENT BOND
To City of Pasco, Washington
Bond No. 107368795
The City of Pasco, Washington, City has awarded to Fogle Pump & Supply. Inc. (Principal), a contract for
the construction of the project designated as Farm Well #3 Cleaning and Rehabilitation, Project No.
21-008, in Pasco, Washington (Contract), and said Principal is required under the terms of that Contract
to furnish a payment bond in accord with Title 39.08 Revised Code of Washington (RCW).
The principal, and Travelers Casualty and Surety Company (Surety), a corporation organized under the
laws of the State of CT and licensed to do business in the State of Washington as surety and named in the
current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the
Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the
City, in the sum of ***Twenty Three Thousand Three Hundred Eighty Two and No/100*** US Dollars
($23,382.00) Total Contract Amount, subject to the provisions herein.
This statutory payment bond shall become null and void, if and when the Principal, its heirs, executors,
administrators, successors, or assigns shall pay all persons in accordance with RCW Titles 39.08, and 39.12
including all workers, laborers, mechanics, subcontractors, and material suppliers for the carrying on of
such work, and all taxes incurred on said Contract under Title 50 and 51 RCW an all taxes imposed on the
Principal under Title 82 RCW; and if such payment obligations have not been fulfilled, this bond shall
remain in full force and effect.
The Surety for value received agrees that no change, extension of time, alteration or addition to the terms
of the Contract, the specifications accompanying the Contract, or to the work to be performed under the
Contract shall in any way affect its obligation on this bond, except as provided herein, and waives notice
of any change, extension of time, alteration or addition to the terms of the Contract or the work
performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract
that increase the total amount to be paid the Principal shall automatically increase the obligation of the
Surety on this bond and notice to Surety is not required for such increased obligation.
This bond may be executed in two (2) original counterparts and shall be signed by the parties' duly
authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original
power of attorney for the officer executing on behalf of the surety.
PRINCIPAL Fogle Pump & Supply, Inc.
A (,(lflm.11 f�ft& 02/18/2021
Principal Signature " Date
Al �1 ���EF, I,(-/
Printed Name
01 rP ohs' D Def Lh.J
Title
SURETY Travelers Casualty and Surety Company
�g . &
02 1 2021
Surety Sign ure Date
Shelly Donovan
Printed Name
Attorney In Fact
Title
Name, address, and telephone of local office/agent of Surety Company is:
Affiant Insurance Services, Inc.
818 W. Riverside Ave., Ste. 800, Spokane, WA 99201, (509) 324-3025
Approved as to form:
Signature
Title
PB -1
Date
TRAVELERS
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint SHELLY DONOVAN of SPOKANE ,
Washington , their true and lawful Attorney -in -Fact 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 Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 17th day of January,
2019.
��� ',,1Y AAO •.� �`-
,%+� 0010E �o
State of Connecticut
City of Hartford ss.
By: '444�
Robert L. Rane , enior Vice President
On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President
of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance 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 said
Companies by himself as a duly authorized officer.
IN WITNESS WHEREOF, I hereunto set my hand and official seal. All
My Commission expires the 30th day of June, 2021 * 4*0
rue`% Anna P. Nowik, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance 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 Attomeys-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 Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance 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 remains in full force and effect.
Dated this 18th day of February , 2021
V ANS.k
4 `?�pw*:�%
- aCOWn
✓ ♦
sr Z�2�
Kevin E. Hughes, Assiltant Secretary
To verify the authenticity of this Power ofAttorney, please call us at 1-800-421-3880.
Please refer to the above-named Attorney -in -Fact and the details of the bond to which this Power of Attorney is attached.
AC Rte' FOGLPUM-01
�....�- CERTIFICATE OF LIABILITY INSURANCE
T U MATE IS OWED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MMM UPON THE CEIMFICATECEITIVICATE DOES NOT FlOLl1ER. 7iN8
BELOifN. THIS CERTI TEFOF INSURANCE DOES NOT CONSTITUTE Y OR 14EGATNELY AMEND, CONTRAD OR S BETWEEN TER THE CO7i1E�i&iUDKi GE AFFORDED DY THE POLICES
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.MWOR�(s). AUTHORIZED
TANT: 8 the Cate holder Is an INSURED, the POLL- {ies) mast have ADDITIONAL INSURED Provisions or be ando eW.
If SUBROGATION IS WANED, subject to the tarns and conditm of the Paltctr certain Policies map require an andorseanent. A st olemerd on
this cardficats does not corder rights to the csrdliabe Itoldr in Lieu of such s ,
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i'Alliant Insurance Services. Inc -,CT MOBS
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818 IN Riverside Ave Sw 800 Zia-* (W 3 85 i+KI Spokane, WA 99201 �k
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Fogle Pump 3 Supply. htc. _
22.50 N Hiphrwap 395 rtuna� a
COW% WA 89114
statRtelt r -
-------CIeR�TE pW@f:R: REVISIDl1 NUMBER:
_
THIS IS TO CERTIFY THAT THE pCgMES OF ViSLgW CE UgTED BELOW HAVE SEN ISSUED 1 OIIiE INSURED NANyI LIABOVE FOR THE POLJCY PERIOD
CATER NOTVYfT145TANDIfiO ANY REpUIR M TElikt OR CONDMON OF ANY CONTRACT OR OTHER DOCL A ENT 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 PND CLAW.
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DWIWTION OF OPERATIONS t LOCATIONa l VE)eM" 1e1. R,wnyrks ede,�lul�, f 6e 4"Cmd If nwm ap"s Is romki " - T,
RE: Agreemsrt No. 21,0W for Desert Sunset �on Wait CkardrrQ and Ret-,! i on
City of „ Its of kw% o4ficlrft, agents, employe" i volunteers are named as additional insured as R rekftB to yenerWi welwr of
�granW as It retetea to general Uty In of ice with the Ua ma and condttlons of fm Polk". The above °= On iE I;
roquimd by wrItfeo contrwt M P and where
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CAUAWN
!SHOULD ANY OF THE ARM DESCRIBED POLJC*3 RE THE MWWAYM DA THEREOF. NOTICE WILL BE D€LIV€REO IN
111 City of Pasco, ropct oor ACCORDANCE WITH THE POUCY pROviS MS
Pubiie„ Warks Project Coordinator
1025 S Cray St
Pasco, WA 99301 ANTHOtUZED RPMMWATNE - -
ACORD 252018103 _ —j
� ) m 1888-2013 ACORD—C- OR- _
PORATION. A9 rsasrvad.
The ACORD name and logo erre regisbred marks of ACOFW
COMMERCIAL GENERAL, LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
GENERAL LIABILITY ELITE EXTENSION
This endorsement mxlfres insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
The COMMERCIAL GENERAL LIABILITY COVERAGE FORM
is amended to include the following clarifications and
extensions of coiteraW. The provisions of the Coverage Form apply unless modified by endorsement
A. EXPECTED OR INTENDED INJURY
The a negate limit fisted abcve Is the most we wIn
Sec a I — Coverage A, Exclusion a. is amended
pay for all damages because of "property damage,
as follows:
to property in the care custody and control of or
a Bodily injury- or "property damage, expected
property loaned to an insured during the policy
or intended from the standpoint of an insured.
period.
This exctusbn does not apply to "bodily injury"
Any payment we make for damages bemuse of
or 'property damage' resulting from the use of
, property damage' to property In the rare, custody
reasoroble force to protect persons or property.
and control of or property barred to an Insured will
B. NON -OWNED WATERCRAFT
apply ,against the General Aggregate Limit shown in
8oction i — Coverage A. Exclusion 9.(2) is
the declarations.
ernencbd as follows:
b, Our obligation to g your
� damages e lf
only
(2) A watercraft you do not own that is:
applies to damages in
excess of the deductible amount listed above.
(a) Less than 60 feet long; and
We may pay any part or all of the deductible
(b) Not being used to ca
carry person(s) or
amount fisted above. We may pay any part or
all of the deductible amount to effect settlement
proptrty for a charge;
C. EXTENDED PROPERTY DAMAGE COVERAGE
of any cern or `suit and upon notification by
us, you will promptly reirnburse us for that part
Section I — Coverage A, Exclusions j.(3) and (4) is
of the deductible we paid.
amended to add the following:
c. If two or more coverages apply under one
Paragraphs (3) and (4) of this exclusion do not
"oocu", only the highest per claim
apply to tools or equipment loaned to you, provided
deductible applicable to these coverages will
they are not being used to perform operations at
apply•
the time of loss.
d. Insurance provided by this provision is excess
SCHEDULE
over any other Insurance, whether primary,
excess, contingent or any other basis. Since
Lirrdts Of insurirrca Deductible
providve ed by this endorsement is
_
$5,0 Each _ 6250 Per Chun
_ --
excess,
excess, we will hano duty to defend any
claim or "suit' to which insurance provided by
$10,000 Annual ate
this endorsement applies if any other insurer
ar. The each occurrence limit listed above is the
has a duty to defend such a claim or `suit. If
no other insurer defends, we will undertake to
most we will pay for all damages because of
"property
do so but we will be entitled to the insured's
damage to property in the care,
custody and control of or property loaned to an
rights against all those other insurers.
D.
insured as the result of any one "occurrence",
PROPERTY DAMAGE —ELEVATORS
regardless of the number of.
SerAlon I — Coverage A.2. Exclusions paragraphs
(t) insureds;
j-(3), j-(4), j.{8) and k. do not apply to use of
(2) claims made or "suits' brought;
elevators. This insurance afforded by this provision
is
excess over any valid and collectible property
(3) persons or organizations making claims or
insurance (including any deductible) available to
bringing "suits".
the insured and Section IV — Commercial General
Liability Conditions Paragraph 4. Other
Insurance is changed accordingly.
CG7578(2-19) includes copyrIgMe l of LSo Praperti,. tcrc, rvitb ft permission. Pape 1 of 6
E. FIRE, LK*frN G OR E) OSIQNDAMAGE
Except w ie a It Is used In the tem 'hostile firer, r, the
word fine Includes fire, lightning or explosions wherever
4 appears In On Coverage Dorm.
Under Section i – Coverage A, the lest paragraph
(after the excisions) is repWced with the following:
Exclusions c. through n. do not apply to damage by
fine, smoke or from automatc fire protections
systems to s while rented to you or
Thr occupied by you with Permission of the
owner. A separate limit of Insurance applies to this
coverage as described in Section Ili – Limits of
IMUNWAL
F. MEDICAL PAYMENTS
if Section i – Cxiveme C. Medical Payntevift
Coverage is not ottilerwiseo— ezc:luded from this
Coverage Frrrrt
The requirenumt, in the insuring Agrearrient of
Coverage C., that Sxpensft must be incurred and
reported to us within one yew of the accident date Is
changed to throe .
G. SUPPLEMENTARY PAYMENTS
SuppWrientary PaYments – Coverages A and B
Paragraphs IAL and 1.d, are replaced by the
foAawi'ng;
1.b.Up to $5,000 for cost of bell bonds required
because of accidents or traffic law violations
arising out of the use of any vehicle to which the
Bodily Injury Liability Coverage applim We do
not have to A RMh these bonds.
1.d.Ail reasonable expenses lured by the insured
at our request to assist us in the investigation► or
defense of the claim or "suis, irctudng actual
loss of GwnkW up to $500 a day because of
time off from work.
K SUBSIDIARIES AS INSUREDS
Section H – Who Is An Insured is amended to add
the following:
1.f. Any legally inoorporaled subsidiary in which you
own more than 50% of the voting stock on the
effective date of this pocky. HarMwever, insured
does not include any subsidiary that is an insured
under airy other general or would
ham been an insured under such a policy but for
termination of that pokey or the exhaustion of that
policy's Imits of liability.
BLANKET ADDITIONAL INSUREDS – AS
REQUIRED BY CONTRACT
1. Section 0 – Who is An Insured is amended to
include as an additional Insured any persort(s) or
organizations) UtOd to provisions in Paragraph
2. below, (hereinafter referred to as additional
insured) when you and such person(s) or
crWization(s) have agreed in a written contract
or witten agreement that such person(s) or
organization(s) be added as an additional insured
ars your ley pied that the written contest or
agreement is:
AL Currently in effect or becomes effective
during the policy period; and
b. Executed prior to an "occurrence" or
offense to which this tnaurance would
apply.
However, the durance afforded to such
additional insured:
a. Only applies to the extent permitted by law,
and
b. Will not be broader than that which you are
required by the contract or agreement t to
provide for such additional insured; and
c. Applies only if the person or organUation is
not specifically named as an additional
insured under any other provision of, or
endorsement added to, Section U – Who
Is An Insured of this policy.
2. As provided herein, the insurance coverage
provided to such additional insureds is limited
to:
si. Any Controlling Intent, but ortty with
reaped to their liability arising out of their
financial control of you; or premises they
own, maim, or control while you lease or
spy these premises.
This insurance does not apply to struc h rat
alterations, new construction and
demolition operations performed by or for
that person or organizion.
b. Any architect, engineer, or surveyor
engaged by you but only with respect to
liability for 'bodily irJury", "Property
damage" or "personal and advertising
injury" caused, in whole or in part, by your
acts or omissions or the acts or omissions
of those acting on your behalf:
(1) In connecWn with your premises; or
(2) In the performance of your ongoing
operations.
With respect to the insurance afforded to
these additional insureds, the following
additional exclusion applies:
This insurance does not apply to "boddy
Injury", "PmPer y darmage" or "personal and
advertising injury" arlclng out of the
rendering of or the failure to render any
professional services by or for you.
including:
(1) The preparing. approving, or failing to
prime or approve. maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; or
(2) Supervisory, inspection, architectural or
engineering activities.
CG7578(2-18) iratliicles covyiVrbd trial of 160 PropotoK sbm wm ft isiaia. Pap 2 of 6
This exclusion applies even if the claims
against any Insured allege negligence or
other wrongdoing in the supervision, hiring,
employment, training or monitoring of
others by that Insured, if the "occurrence"
which caused the "bodily injury" or
"Property darnage", or the offense which
caused the "personal and advertising
injury". Involved the rendering of or the
failure to render any professional services
by or for you.
c. Any manager or lessor of a premises
leased to you, but only with respect to
liabiirty arising out Of the ownership,
maintenance or use of that part of a
Premises leased to you, subject to the
following arclitiorial exclusions:
This insurance does not apply to:
(1) Any 'occairreriW which takes place
ager YOu cease to be a tenant in alit
prerrirsas.
(2) SbUcturat a< rations, new construction
or dm*ftion operations performed by
or on behalf of such additional insured.
d. Any state or governmental agency or
subdivision or pol" subdivision, subjed to
the following:
(1) This insurance applies only with respect
to the b1lowing hazards for which any
state or govicemrner"I agency or
subdivision or poral subd'nrision has
Issued a permit OF authorization in
cotnectim with premises you own, rent
Or control and to which this Insurance
applies:
(a) The existence,maintenance, repair,
construction, erection or removal of
advert ing signs,
canopies, car entrances, coal
how, driyeways, manholes,
hoist away Openings,
vaults. street banners or
decorations and sing exposures;
or
(b) The crosbnxction, erection or
removal of ; or
(c) The Ownership. ma ntertance or use
Of any elevators covered by this
Imo.
(2) This Insurance applies only with resped
to Operations performed by you or on
your behalf for which any state or
governmental agency or subdivision or
political subdivision has issued a permit
or authorization.
This insurance does not apply to:
(a) `Roddy injury', or
rrnd advertising VW
arising out of operations perlbrmed
for the federal goverrxnent, status Or
municipality or
(b) *SO* irW' Or "property d~
included within the "products-
completed
producecompleted operations haizwd".
e. Any verKlor, but only with rases to 'bodily
illur/ or 'property daniag#" arising out of
Products" which are distributed or sold
In the regular cocase of the vendor's
business_
With respect to the insurance afforded to
these vendors, the following additional
exclusions apply:
(1) The insurance afforded any vendor does
not apply to.
(a) "Y Injury' or "Property „
for which any vendor is obligated to
pay damages by reason of the
as _ _ bion of liability in a contract or
agreement. This bion does not
apply to liability for dam's that any
vendor would have in the absence of
the contract or agreement
(b) Any express warranty unauthorized
by you;
(c) Any physical or chemical change in
the product made intentionally by
any vendor,
(d) Repackaging, except when
unpacked solely for the purpose of
Inspection, demonstration, testing,
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the original
container;
(e) Any failure to make such
Inspections, adjustrnents, tests or
servicing as any vendor has
agreed to make or normally
undertakes to make in the usual
course of business, in connection
with the distribution or sale of the
products;
(f) Demonstration, installation,
servicing or repair operations,
except such operations performed
at any vendor's premises in
connection with the sale of the
product;
(9) Products which, after distribution or
sale by you, have been labeled or
relabeled or used as a container,
part or ingredient of any other thing
or substance by or for any vendor;
or
GG7578(2-19) Incktdec Mpyrlght o-, terial of 150 Properfiss, Inc. with its pamltslart. Page 3 o€ 6
(h) "Bodily injury" or "property
doge" arising out of the sole
negligence of any vendor for its
own ads or omissions or those of
its employees or anyone else
acting or its behalf. However, this
exclusion does not apply to:
(i) The exceptions contained in
Subparagraphs (d) or (f); or
(ii) Such inspections, adjustments,
tests or servicing as any
vendor has agreed to make or
normal undertakes to make in
the usual course of business,
in connection with the
distnbution or sale of the
products.
(2) This insurance does not apply to any
insured person or organization, from
whom you haute acquiree! such
Products, or any ingredient, part or
container, entering into, accompanying
or containing such products.
f. Any Mor%pqee, Assignee Or Receiver, but
only with respect to their liability as
mortgagee, assignee, or receiver and
arising out of the ownership, maintenance,
or use of the premises by you.
This insurance does not apply to structural
alterations, new construction and
demolition operations performed by or for
that person or organization.
g. Any Owners Or Other Interests From
Whom Laird Has Been Leased, but only
with respect to liability arising out of the
ownership, maintenance or use of that part
of the land leased to you.
With respect to the insurance afforded to
these additional insureds, the following
additional exclusions apply
(1) This insurance does not apply to:
(a) Any "occurrence" which takes
place aft you cease to lease that
land; or
(b) Structural alterations, new
constructio► or demolition
operlons performed by or on
behalf of such additional insured.
h. Any person or organization from whom you
lease equipment, but only with respect to
liability for "bodily injury. 'property
damage° or "personal and advertising
injury' caused, in whole or in part by your
maintenance, operation or use of
equipment leased to you by such person(s)
or organization(s).
A person's or organization's status as an
additional insured under this endorsement
ends when their contract or agreement with
You for such leased equipment ends.
With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to any "occurrence" which
takes place after the equipment lease
expires.
I. Any Owners, Lessees, or Contractors for
whom you are performog operations, but
only with respect to liability for "bodily
injury", "Property damage" or "personal and
advertising injury`" caused, in whole or in
part, by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting
on your behalf;
in the performance of your ongoing
operations for the additional insured
A person's or organization's status as an
additional insured under this endorsement
ends when your operations for that
additional insured are completed.
With respect to the insurance afforded to
these additional insureds, the following
additional exclusions appy.
This insurance does not apply to. -
(1)
o:
(1) "Bodily injury', "Property damage- or
"Personal and advertising injury' arising
out of the rendering of. or the failure to
render, any professional architectural,
engineering or surveying services,
including:
(a) The prepari►g, approving, or
to prepare or appmve, maps, shop
drawings,
trigs, opinions, reports, surveys,
f
, change orders or
drawings and ns; or
(b) Supervisory, inspection, ard*edural
or engineening activities.
This exclusion apples even if the claims
against any insured allege negligence or
other wrongdoing in the supervision, hiring,
emPloyment, training or monitoring of
others by that insured, if the "occurrence"
which caused the "bodily injury" or
"Property damage". or the offense which
caused the "personal and advertising
injury", involved the rendering of or the
failure to render any professional
architectural, engineering or surveying
services.
(2) "Bodily injury" or "property damage"
occurring after:
CG7578(2-19) kwudes copyrww "WWW of Rio P , km with its perndsators. Page 4 of 6
(a) All work, including materials, parts
This endorsement shall not increase the
or equipment furnished in
connection with such work, on the
applicable Limits of Insurance shown in the
Declarations.
pmfe t (other than service,
maintenance or repairs) to be
J.
COVERAGE FOR INJURY TO CO -EMPLOYEES
Performed by or on behalf of the
AND/OR YOUR OTHER VOLUNTEER WORI(ERS
additional insured(s) at the location
Section 11— Who is an Imured, Paragraph 2a. (1) is
of the covered operations has been
amended tD add the g:
completed; or
e. Paragraphs (a), (b), and (c) do not apply to your
(b) That portion of "your work' out of
which the injury or damage arises
'employees' or %101urteer workers° with reaped
to "bodily injury' to a co'empioyee' or other
has been put to its intended use by
"vokinbeer worker".
any Person or organization other
another contractor
thncontractor
Damages
owed
Nad to an inrn `
injured co -"e° or
or
engaged In
Performing operations for a
nteer worker" will be reduced by any
amount paid or available to the injuc+ad co -
„ " co -
Principal as apart of the same
or "volunteer worker' under any
other valid and collectible insurance.
J. Any Grantor of Licenses to you, but only
K
HEALTH CARE SERVICE PROFESSIONALS AS
INSUREDS - INCIDENTAL MALPRACTICE
with respect to their liabirty as grantor of
lice to you.
Section If — Who is, an Para 2.a, 1
( )
Their status as additional insured under
(d) is amended as RAms:
this enclorsement ends when:
This provision does not apply to Nunes, Emergency
1. The tense granted to you by such
Medical Technicians, or Paramedics who Provide
Prd6ssional hems care services on your behalf,
1 (e) organization(s) expires; or
2. Your tense is terminated or revoked
Hotianever tht exception does not apply f in
y you are the business � of provWing any such
by such p(s) or organization(s)
peal
prior to expiration of the license as
stipulated by the contract or
L
NEWLY FORMED OR ACQUIRED
agreement
ORC;At�AZAT10N8
k. Any Grantor of Franchise, but only with
Section II — Who Is An insured, Paragraph 3.& is
respect to their liability as grantor of a
replaced bythe folkyMng:
franchise to you.
3.a. Coverage under this proviWn is afforded unfit
I. Any Co-owner of Insured Premises, but
the end ofthe policy period.
only with resWt to their liability as co-
This provision does not apply if newly formed or
owner of any insured premises.
acquired orgamations coverage is excluded either by
M. Any Concessionaires Trading Under Your
the provisions of the Coverage Foran or by
Name. but only with respect to their liability
as a concessionaire trading under your
M.
DAMAGE TO PREMISES RENTED TO YOU
name'
Section III — Lknits of Irourance, Paragraph S. is
3. Any insurance provided to any additional
wed by the followira-
insured does not apply to 'bodily injury°',
"property damage or 'personal and advertising
Std to &a. above, the Damage To Premises
injury' arising out of the sole negligence or
Rented To You Limit, or $500,000, wtkhever is
higher, is the most we will Pay under Courage A for
wul misconduct of the additional Insured or itsecause
'employees'
o any
to one
arts. or any otter
representative of the additional insured.
promises, while rented
} or in the case of
damage by face, smoke � from automotic
4. With respect to the insurance afforded to these
protection systems, while rented to you or terr>p edgy
additional insureds, the following Is added to
occupied by You with permission of the owner.
Section III —Limits of insurances:
N.
MEDICAL PAYMENTS — INCREASED LIMITS
If coverage provided to any additional insured
is required by a contract or agreement, the
Section III — Limits of Insurance, Paragraph 7. is
most we will pay on behalf of the additional
replaced by the following:
insured is the amount of insurance:
above, 7, eCt t0 h above, $10,000 is the
a. Required by the contract or agreement; or
Medical Expense Limit we will pay under
Coverage C for all medical expenses because of
b. Available under the ale Limits of
'bodily injury" sustained by any one person,
Insurance shown in the Declarations;
unless the amount shown on the Decimations of
whichever is less.
this Coverage Part for Medical Expense Limit
states:
CG7578{2-19) Includes nwWlal of 130 Propvtks, kc. Wtt b per *pion. Page 5 ct 6
(a) No Coverage; or
(b) $1,000; or
(c) $5,000; or
(d) A limit higher than $10,000.
O. DUTIES IN THE EVENT OF OCCURRENCE,
OFFENSE, CLAN OR SUIT
Section N — Commercial General Liabift
Conditions Paragraph Z. is arrrerrded to add the
Wig:
e. The requirement in Condition 2.a. that you must
see to A that we are notified as soon as
practof an "occurrence' or an offense
which may result in a claim, applies only when the
"oaxtrrence or offense is known to:
(1) You, ft you are an individual or a limited
liability corra,ry,
(2) A partner, if you are a partnership;
(3) A member or manager, I you are a 6rnked
liability company,
(4) An "executive officer' or insurance manager,
if you are a corporation; or
(5) A trustft if you are a trust.
f. The requirerreft in Condition 21x tied you must
SM to it that we receive notice of a claim or "sub"
as soon as will not be considered
breached urt the breach occurs after such
claim or "suir is known to:
(1) You. if you are an individual or a limited
liability company,
(2) A partner, If you are a partnership;
(3) A member or rr, agor, if you are a limited
liability company;
(4) An "executive officer" or insurance manager,
if you are a corporation; or
(5) A trustee, if you are a trust.
PRIMMY AND NONCONTRIBUTORY
ADDITIONAL INSURED EXTENSION
Sewn iV — Cominercial General Liability
Conditions Pah C Other Insurance is
amended to add the
This Wince is primary to and will not seek
contribution from any other insurance available to an
additional insured under your policy provided that
(1) That additional insured is a Named Insured under
such oftw insurance, and
(2) You have agreed in writing in a contact or
agreement that this insurance would be primary
and would not seek contribution from any other
insurance available to the additional insured.
However, y the additional insured has been
added as an additional insured an other polies,
whether perry, excess, contingent or on any
other basis, this insurance is excess over any
other insurance regardless of the written
agreement between you and an additionM
insured.
Q. UNINTENTIONAL FAILURE TO DISCLOSE
EXPOSURES
Section IV — Cornrfrercial General LiaNy
Conditions Paragraph 6. Representations is
amended to add the foWwing:
If you uninte Abnaffy fait to discicee any exposures
existing at the inception date of your policy, we ww not
deny coverage under the Coverage Form so*
because of such failure to disclose. However, this
provision does not affect our right to Coliect addritmial
premium or exercise our right of canceWon or non-
renewal.
This provision does not apply to any known injury
or damage which is excluded under any other
provision of this policy.
R. WAIVER OF TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US
Section IV — COrnnwcW General Liability
Condition. Paragraph sL Trorwer Of Rights Of
Recovery Against Others To Us is amended to
add the following:
We waive any right of recovery we may have
against any peen or organization because of
payments we make for injury or damage arising out
Of
1. Your ongoing operations; or
2. "Your work' included in the "pioducts-
compkded operations hazard'.
However, this waiver applies only when you have
agreed in writing to waive such rights of recovery in
a contract or agreement, and only if the contract or
agreement-
1.
greement1. Is in effect or becomes effective during the term
of this policy; and
2. Was executed prior to loss.
S. MENTAL ANGUISH
Section V — Definition 3. is iced by the foil p:
'Bodily injury' means bodily injury, sickness or
disease sustained by a person, inciudhg mental
anguish or death r"Li ing from bodily injury,
sickness or disease.
T. LIBERALIZATION
If we revise this endorsement to provide greater
coverage without additional premium charge, we
will automatically provide the additional coverage to
all endorsement holders as of the day the revision
is effective in your state.
CG757t!{2--19) lndud" coPyrWftd of ISO Propwtin, tent. irate ftt pwrriasion. Page 6 d 6
PERFORMANCE BOND
BOND TO THE CITY OF PASC O
Bond No. 107368794
KNOW ALL MEN BY THESE PRESENTS:
That we, the undersigned, Fogle Pump & Supply, Inc. as principal, and Travelers Casualty and Suretv
Company a corporation organized and existing under the laws of the State of C as a surety corporation,
and qualified under the laws of the State of Washington to become surety upon bonds of contractors,
as surety, are jointly and severally held and firmly bound to the City of Pasco in the penal sum of
***Twentt� Three Thousand Three Hundred for the payment
of which sum on demand we bind ourselves and our successors, heirs, administrators or personal
representatives as the case may be.
This obligation is entered into a pursuance of the statutes of the State of Washington, and ordinances of
the City of Pasco.
Dated at Spokane. Washington, this 18th day of February. 2021.
Nevertheless, the conditions of the above obligation are such that:
WHEREAS, pursuant to action taken by the City Council of the City on _ 20____, the
Mayor and City Clerk of the City of Pasco have let or are about to let to the said Fogle Pump & Supply, Inc.
the above bounden principal, a certain contract, the same contract being numbered 21-007 and providing
for Farm Well #2 Cleaning and Rehabilitation (which contract is referred to herein and is made a part
hereof as though attached hereto.)
WHEREAS, the said principal has accepted, or is about to accept the said contract, and undertake to
perform the work wherein provided for in the manner and within the time set forth.
NOW, THEREFORE, if the said ale Pump & Supply, Inc. shall faithfully perform all of the provisions of
said contract in the manner and within the time therein set forth, or within such extensions of the time
as may be granted under the contract, and shall pay all laborers, mechanics, subcontractors, and material
men, and all persons who shall supply said principal or subcontractors with provisions and supplies for the
carrying on of said work, and shall indemnify and hold said City of Pasco harmless from any loss or damage
occasioned to any person or property by reason of any carelessness or negligence on the part of said
principal, or any subcontractor in the performance of said work, and shall indemnify and hold the City of
Pasco harmless from any damage or expense by reason or failure of performance as specified in said
contract or from defects appearing or developing In the material or workmanship provided or performed
under said contract after its acceptance thereof by the City of Pasco, then and in that event this obligations
shall be void; but otherwise it shall be and remain in full force and effect.
Approved as to Form:
Travelers Casuafyand Surety Company Fogle Pump & Supply,, Inc.
Surety ShefW Donovan, Attorney In Fact Contractor
PB -1
PAYMENT BUND
To City of Pasco, Washington
Bond No. 107368794
The City of Pasco, Washington, City has awarded to Fogle Puma & Suyely. Inc. (Principal), a contract for
the construction of the project designated as Farm Well #2 Cleaning and Rehabilitation, Project No. 21-
007 in Pasco, Washington (Contract), and said Principal is required under the terms of that Contract to
furnish a payment bond in accord with Title 39.08 Revised Code of Washington (RCW).
The principal, and Travelers Casualty and Surety Company (Surety), a corporation organized under the
laws of the State of CT and licensed to do business in the State of Washington as surety and named in the
current list of "Surety Companies Acceptable in Federal Bonds" as published in the Federal Register by the
Audit Staff Bureau of Accounts, U.S. Treasury Dept., are jointly and severally held and firmly bound to the
City, in the sum of ***Twerity Three Thousand Three Hundred Eighty Two and No!100*** US Dollars
(523.382.00). Total Contract Amount, subject to the provisions herein.
This statutory paymerd bond shall become null and void, if and when the Principal, its heirs, executors,
administrators, successors, or assigns shall pay all persons in accordance with RCW Titles 39.08, and 39.12
including all workers, laborers, mechanics, subcontractors, and material suppliers for the carrying on of
such work, and all taxes incurred on said Contract under Title 50 and 51 RCW an all taxes imposed on the
Principal under Title 82 RCW; and If such payment obligations have not been fulfilled, this bond shall
remain in full force and effect.
The Surety for value received agrees that no change, extension of time, alteration or addition to the terms
of the Contract, the specifications accompanying the Contract, or to the work to be performed under the
Contract shall in any way affect Its obligation on this bond, except as provided herein, and waives notice
of any change, extension of time, alteration or addition to the terms of the Contract or the work
performed. The Surety agrees that modifications and changes to the terms and conditions of the Contract
that increase the total amount to be paid the Principal shall automatically increase the obligation of the
Surety on this bond and notice to Surety is not required for such increased obligation.
This bond may be executed in two (2) original counterparts and shall be signed by the parties' duly
authorized officers. This bond will only be accepted if it is accompanied by a fully executed and original
power of attorney for the officer executing on behalf of the surety.
PRINCIPAL Fogle Pump & Supply, Inc.
I
w l f! ' ,,rMI/�I TT7 11..E --02/18/2021
02/18/2021
Principal Signatures Date
"41(� Ur -r ;1
Printed Name =`
SURETY Travelers Casualty and Surety Company
i.- 211 EU --021
Surety Sign re Date
Shelly Donovan
Printed Name
Dirt, Uf OL Uim' S Attorney In Fact _
Title ITitle
Name, address, and telephone of local office/agent of Surety Company is:
A ai n I—ns uranG` ervices, inc. -
818 W. Riverside Ave., Ste. 800, Spokane, WA 99201, (509) 324-3025
Approved as to form:
Signature
Title
PB -1
Date
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
,TRAVELERS'J'
SL Paul Fire and Marine Insurance Company
POWER OF ATTORNEY --
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St
Pout Fre and Marine insurance Company are corporations duty organized under the laws of the State of Connecticut (harem coitectvety called the
'Companies"), and that the Companies do hereby make, constitute and appoint SHELLY DONOVAN of SPOKANE
Washington , their true and iawNI Attorney -in -Fact to sign, execute, seat and acknowledge any and all bonds, recograzances,
conditional undertakings and other wr€tings obligatory in the nature thereof on buff 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 WifNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seats to be hereto affixed, this 17th day of January,
2015.
NyCCM Noel
State of Connecticut 'e
BY-
City of Hartford ss
Robert L. Rana , aria' Vitae President
On this the 17th day of January, 2018, before me personally appeared Robert L. Rang, who acknowledged himself to be the Senior lice President
of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance 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 said
Companies by himself as a duty authorized officer.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission expires the 30th day of June, 2021
loom
�d !!tom � r
pulm Anna P. Nowik, Notary Public
This Power of Attorney is granted under and by the authority of the foibwing resolutions adopted by the Boards of DirectDrs of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in full
force and effect reading as follows:
RESOLVED, that the Chairman, the Pres€dent, any Vice Chairman, any Executive Vice President, any Seng Vice President, any Vice President any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Atlomeys-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 author may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizant es, 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, arty 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 fled 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 Vm 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 duty attested and seated with the Company's seat by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if
required) by one or more Attomeys4n-Fact and Agus pursuant to the power prescribed in his or her certfficate 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: Presiderrt, any Executive Vice President, any Senior Vice President, any Vice
PreskienL 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 -Fad for purposes only of
executing and attesting bonds and undertakings and other writings obligatory in the mature thereof, and any such Power of Attorney or certificate tearing
such facsenile signature or facsimile seat shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facalmile seal shall be valid and binding on the Company in the future with respect to an bond or understanding nding to which it is attached..
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St Paul Fire and Marine insurance Company, do hereby certify that the above and forging is a true and correct copy of the Pourer of
Attorney executed by said Companies, which remains in full force and effect.
Dated this lbtth day of February , 2021
-5✓A�r � ��.,a,;-. .tM°1t
ad v�
.
eelVis, +_ �
Kevin:E. Hughes, Assn :tent Secretary
7b WWMY the AUIUWW�ofthis Power ofAttormw, phmae CON as at 1-800-4n-3WV.
Pmserefer fotheaborre-fla~Athmnna-rrfa�ctAad the 4thuft of theboad to whArh this Pbwar of)[Mrrw AratWdkgaL
Change Order Quote
Farm Well #3
Item No.
Description
Unit
Unit, t_. Frio
Quantity
Extended Price
1
Well Development Labor
(2 guys 20 hrs each)
hrs
100.00
40
4000.00
2
Equipment use
Cable tool/Frac Unit
hrs
150.00
20
3000.00
Sub Total
7000.0
Tax Rate (8.6% /
8.0% Circle
appropriate tax rate
560.00
Total
S 7560.00
By:
Alaina Fogle Date
Director of Operations