12-105369CITY OF ..A� PERMIT
Federal waf ECEIVED
aku �P�5,sTyvWdV 2a 204LPPLICATION
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CITY OF FEDERAL WAIF
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S. MF CO ME PL ❑ ENV P
SITE ADDRESS
SUITE/UNIT #
L
200 [ S 3 2-of
PROJECT VALUATION
$
ZONING
ASSESSOR'S TAX/PARCEL #
2z -4 0 Da La
-7( -
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION YENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
� yid iQe.EcnS i'rwcT t vr� o F S
PROJECT DESCRIPTION
Detailed description of work to
- -
- -
be included on this permit only
PRIMARY PHONE
PROPERTY OWNER
I45t L C.
MA [LING ADDRESS
E-MAIL
I/
iZAM fl r'J sr , T SOa
CITY STATE ZIP
PHONE
_
NAME
~/3 D
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
�2ou�
PHONE
25 3
.1AP�/ r�
MAILING ADDRESS /
w
E-MAIL
APPLICANT
lel S
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CITY
/e, / r
STATE
ZIP
FAX
2S3 9348 -1
PROJECT CONTACT
NAME
PHONE
2 S3 838 e. / 13
(The individual to receive and
MAILING ADDRESS
E-MAIL
rej bro.on �5,ue:r; l.ca�
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
2.5g
ALTERNATE CONTACT NAME-
PHONE
E-MAIL
PROJECT FINANCING
NAME
-13 OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the uwrk authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the Owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as apart of this application.
i
r
SIGNATURE: f __ DATE // Z8 I2—
PRINT NAME: _ - '►- t n e- Wp —
Bulletin #100 -January 1, 2011 Page I of 3 k:�Handouts\Permit Application
MrcHANICAL FjxTURES .
VALUE OF MECHANICAL WORK $-
(a copy of bid or estimate must be rouided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS(commerr,at)
BOILERS
FURNACES HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
-i.L�l1`.�711�11:�L��L'•j i�J:s��---,-:..•til
yy ,��,�y...
Indicate how many of each type of fixture to be i stalled or relocated as part of this project. Do not inclu existing
fixtures to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Tans sinks, TOILETS
WATER PIPING
DISHWASHERS
RAINW TER SYSTEMS URINALS
OTHER (Describe)
DRAINS
SHC7W RS VACUUM 6T2ERIGE
DRINKING FOUNTAINS
SINKS p ;i�rn,/ttU1 ry] WATER HEATS (E;erv;r)
HOSE BIBBS
SUMPS WASHING M HINES
TOTAL FUCTURES
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SY&R PURVEYOR
VALUE OF £70STING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
PRINKLER SYSTEM?
ST:ns
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ No
❑ Yes ❑ No
ti r
AREA DESCRIPTION (in square et) EXJSTIN
ADD
OPOSED TOTAL FOR OFFICE USE
BASEMENT .
FIRST FLOOR (or Mobile Home)
13ECONl7 I' LO()R
COVERED ENTRY
'
DFIC:IC
GARAGE ❑ CARPORT ❑
OTHER (rleseribe).Area
Totals
E
PROMSED-
- )wgcroi•
ESTIMATED SELLING PRICE $
# OF BEDROOMS
11
ILI
Area Occupancy Group(s) _ Construction # of
in Square Feet Stories
Additional Information .
AREA DESCRIPTION
NwBUILDIN
4
ADDITION
CONIMERCIAL — FEE;N-10D11 T.A. �;.ti ►xti, i �ll�'It � 11L�V.r,S;. ;
AREA DESC PTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet 4 f TXpe Stories
I•{1TAi. $UILDI}YG
-
TEN T AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application
kCITY OF
. Federal
December 24, 2012
CITY HALL
Way 33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www.cityoffederalway.com
ESM Consulting Engineers, LLC
Attn: Fred Brown, P.E.
181 S 333d St, Suite 210
Federal Way, WA 98003
RE. Permit #12-105369-00-EN; KOHLS Site Development; 2001 S 3260 ST
Dear Mr. Brown:
The Public Works Department has reviewed the plans submitted for the proposed site preparation work
associated with the new Kohl's at The Commons. Prior to approval of these plans, please address the
following comments:
All sheets —
1) Add the City file number (12-105269-EN) in the space provided above the City approval block.
Sheet C0.1— No comments
Sheet C1.0 — No comments specific to this sheet, however, comments below may reflect on information
provided on this sheet.
Sheet C2.0 —
1) Please note on the plans that the existing Fire Main that is to be disconnected and abandoned shall
be coordinated with South King Fire and Rescue (SKFR). Also, verify with Lakehaven Utility
District if they need to be included in this coordination effort as well.
2) Please be specific (indicate on the plans), what each type of surface feature it is that is to be
demolished or removed, as indicated by the circle with `x' through it.
3) Under the Legend, add a note that the existing building to be demolished is under a separate
permit.
Sheet C2.1-
1) Please be specific (indicate on the plans), what each type of surface feature it is that is to be
demolished or removed, as indicated by the circle with `x' through it.
2) Under the Legend, add a note that the existing building to be demolished is under a separate
permit.
Sheet C3.0 — No comments specific to this sheet, however, comments above and below may reflect on
information provided on this sheet.
ESM Consulting Engineers, L_
Re: Kohl's Site Development
Page 2
Sheet C4.0 —
1) Provide additional information regarding the wall around the loading dock area. Provide
construction type, as well as top and bottom spot elevations along the length of the wall.
2) Is the curbing along the sidewalks (next to the buildings) the same type of curbing around the
landscape planters? If not provide separate details for each.
3) Provide a reference to each curb detail on the plan sheet, and indicate if `typical'.
4) Indicate that the roof drain connections are for `future', and indicate that each is to be capped.
Sheet C4.1-
1) Is the curbing along the sidewalks (next to the buildings) the same type of curbing around the
landscape planters? If not provide separate details for each.
2) Provide a reference to each curb detail on the plan sheet, and indicate if `typical'.
3) It appears that there is a trash and recycling enclosure proposed near catch basin (CB) #2. Please
indicate what this is, and provide construction details in this plan set.
4) In the NW quadrant of the new parking area, four existing storm drain lines converge into a point
that appears to be a location where a catch basin or manhole should be. Please verify that a
structure exists at this junction. If no structure exists at this location, should one be added?
5) There is an existing CB approximately 50 feet north of new CB #3. The leader not indicates a
single 8" pipe to the south. Please verify where this 8" pipe drains to, and if this cannot be
determined, should this CB be connected to the new storm drain system?
6) The pipe between CB #6 and CB #5 appears to have less than one -foot of cover. Please select
another pipe type that can be used where less than one -foot of cover is provided.
7) CB #1 is connected to the north to an existing CB. Please provide the `type' of this existing CB
(1 or 2). If this is a type 1 CB, then it should be replaced with a type 2 CB, since the rim -to -
invert elevations are greater than 5.0 feet.
8) Please indicate if the transformer within the landscape island, near the NW corner of the parking
lot redevelopment, is new or existing.
9) The plans show power, telecomm, and gas services to the existing building. Are these to be
installed under this permit? If so, do they require any approvals or coordination with the utility
purveyor that needs to be noted on the plans? There may be a requirement to obtain a separate
electrical permit from the City's Building Department to install the transformer and/or power
conduits/cables.
10) It seems that ADA ramps may be required to allow access from the HC stalls to the pedestrian
link, as well as from the pedestrian link to the walkways adjacent the buildings. Please verify if
they are required, and provide as necessary. Also provide the necessary details.
Sheet C5.0 - No comments specific to this sheet, however, comments above and below may reflect on
information provided on this sheet.
Sheet C6.0 —
1) A silt fence detail is provided, however, it does not appear that any silt fencing is shown on the
plans. Please indicate the silt fence on the plan view. It is acceptable if no silt fence is planned at
this time, to keep this detail on the plans, but maybe add a note indicating the detail is provided in
the event that conditions and weather may dictate the requirement to install silt fence at such time
it's deemed necessary.
2) Indicate that the item shown on the sediment filter detail is a CB insert.
3) The E/SC Notes provided are not current City standards. Please replace these with our current
notes.
ESM Consulting Engineers, LLC
Re: Kohl's Site Development
Page 3
Sheet C7.0 —
1) The Curb Ramp Detail is out of date. Please replace with our current detail.
2) The sheet has a trash compactor detail on it. Please show on a plan sheet where the compactor
will be located.
Sheet CM - No comments
Sheet L1.0 - No comments specific to this sheet, however, comments above below may reflect on
information provided on this sheet.
Sheet M1 I --
1) Clearly indicate the S 324"' St right of way line.
2) Verify that the proposed landscaping (specifically any trees) will be allowed by the Bonneville
Power Administration (BPA) within their easement.
Sheet L1.2 — No comments
Please revise the plans as necessary and re -submit four (4) copies for further review.
If you have any questions, please contact me at (253) 835-2734, or at
kevin.peterson i�)cityoffederalway.com.
Sincerely,
Kevin Peterson
Engineering Plans Reviewer
KP:dl
enclosure Redline copies of plans
cc: Project File
Day File
L:\csdc\docs\save\33996891087.doc
CITY 4F
Federal
February 6, 2013
CFTY HALL
Way 33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www.cityoffederalway.com
James Palda
Steadfast Commercial Properties
18100 Von Karman, Suite 500
Irvine, CA 92612
Re: AUTHORIZATION TO PROCEED;
Site development/preparation for Kohl's at The Commons
File #12-105369-000-00-EN
Dear Mr. Palda,
The project referenced above has been reviewed for consistency with the Federal Way Revised Code and
other standards, policies and regulations of the Department of Public Works. All applicable fees must be
paid and a performance bond submitted to guarantee the performance of required civil -related work. A
Certificate of Insurance from the contractor, naming the City of Federal Way as an additional insured
must be submitted as well. The plans for the improvements referenced above are hereby conditionally
approved. Construction of the improvements may commence when the conditions of this letter have been
fulfilled_
Prior to starting work, a pre -construction conference with Public Works must be held. To schedule a
pre -construction conference, call Kevin Peterson, Engineering Plans Reviewer, at (253) 835-2734. (Note:
please give a minimum of three working days advance notice to schedule the pre -construction meeting.)
The developer's on -site construction superintendent must attend this meeting in order to receive the
approved plans.
Additional items that may be required prior to starting construction or final project approval are as
follows:
I. All utility agencies have been notified at least two working days prior to any excavation
(Call Before You Dig: 1-800-424-5555).
2. All detours or traffic diversions around the work zone shall be well marked, and shall
provide for safe pedestrian and vehicular passage.
3. All materials and construction shall conform to the current edition of the City of Federal
Way Public Works Development Standards, Washington State Department of
Transportation Standard Specifications for Road, Bridge and Municipal Construction,
King County Road Standards, and the King County Surface Water Design Manual.
4. The applicant must contact Lakehaven Utility District for water and sewer requirements
or permits, and South King Fire and Rescue for any fire -line requirements or permits
and/or fire apparatus access requirements within the construction zone.
Mr. James Palda
Kohl's Site Development at The Commons
February 6, 2013
Page 2
5. Final Review: Following construction approval of the storm water facilities, and prior to
receiving final approval, an "as -built" mylar original (free of stick -on notes and shading)
and two sets of blueprint copies shall be submitted by the applicant's engineer.
6. No final inspection will be scheduled and no Certificate of Occupancy issued prior to the
completion of the engineering improvements authorized for this project and the
acceptance of the as -built submittal by the Public Works Department.
We would also like to take this opportunity to remind you that, per our May 19, 2011 letter, Sub -basin #3
Water Quality improvements shall be completed prior to December 31, 2013, and that bonding for all of
the remaining Commons site water quality improvements shall be finalized prior to beginning work on
any of the Sub -basin water quality improvements.
If you have any questions or concerns regarding this letter, please call Kevin Peterson, Engineering Plans
Reviewer at (253) 835-2734_
Sincerely,
Ken Miller, PE
Deputy Director Public Works
KMAI
cc: Fred Brown, P.E. ESM Consulting Engineers 33400 8 h Ave S, Suite 205, Federal Way, WA 98003
Isaac Conlen, Planning Manager
Project File(kp)
Day File
L=\csdc\docs\save\57393 52054.doc
CITY OF
.1. Federal Way
DATE: December 21, 2012
TO: Isaac Conlen
FROM: Kevin Peterson
SUBJECT: KOHLS - (12-105369-00-EN)
2001 S 320TH ST
Isaac,
MEMORANDUM
Public Works Department
Resubmittal of civil plans, including revisions to the Landscape plans in response to your comments.
RES U M ITTgrMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
Federal Way, WA 98003-6325
CITY OF �
253-835-2607;Fax 253-835-2609
Federal Way DEC 2 0 2012 w ww.dtyoffedera1way.com
CITY OF FEDERAL WAY
CDS
RESU BM ITTAL INFORMATION
This completed form MUST accompany all resubmittals.
**Please note: Additional or revised plans or documents for an active project will not be accepted
unless accompanied by this completed form. Mailed resubmittals that do not include this form or that
do not contain the correct number of copies will be returned or discarded. You are encouraged to
submit a# items in person and to contact the Permit Counter prior to submitting ifyou are not sure
about the number of copies required. **
ANY CHANGES TO DRAWINGS MUST BE CLOUDED.
Project Number: - a - - Jp
Project Name: -�fI
Project Address:
Project Contact: Fx ,& Phone: 2 , 1/-.;?
RESUBMITTED ITEMS:
# of Copies ** I Detailed Description of Item
** Always submit the same number of copies as required for your initial application. **
K EYIN P Resubmittal Requested by : �s�a�- Pert _ Letter Dated: 12 / / rz
tott member)
T OFFICE USE O72��2_
RESUB#.- Distribution Date."[
Dept/Div
Name
# Description
Building
Planning
I
PW
G
Fire
Other
Bulletin #129 —January 1, 2011 Page 1 of I k:\Handouts\Resubmittal Information
CITY OF
�. Federai Way
DATE: 12/13/12
TO: Kevin Peterson /
FROM: Isaac Conle�C-,
SUBJECT: KOHLS - (12-105369-00-EN)
2001 S 320TH ST
Hi Kevin,
Please forward the following comments to the applicant.
MEMORANDUM
Community and Economic Development:
Department
1. Sheet C3.0 indicates the pedestrian paths will match existing pedestrian connection on north side.
Please indicate the material to be used for the pedestrian paths (the landscaping plans show what looks like
striping on asphalt in certain locations — which is not allowed).
2. None of the civil or landscaping plans show the required landscape island at the west end of the
parking row directly south of the Kohl's building (as required by the city's land use approval decision). Please
add this to the plan sheets (adjust landscaping calculations accordingly).
3. Most of the drawings do not show the landscaping planters attached to the south side of the Kohl's
frontage. They probably do not show up (12" in width) at these scales. Consider showing them enlarged
with a note describing this (definitely do something on the landscaping plans to more clearly depict these
features).
4. Condition #2 of the land use approval for this project requires installation of columnar trees (min 6-
feet in height) and shrubs a minimum of 30-inches in height at time of planting in the landscaping islands
along the south side of the building (these are the islands that have now been relocated to south of the
sidewalk on the south side of Kohl's building. I don't see that shrubs 30-inches in height are included. The
trees planted are less than 6-feet in height. Also, no ground cover is shown. Please revise accordingly.
5. Condition #8 of the land use approval for this project requires installation of landscaping and "plaza
features such as seating, lighting, trash receptacles, bike racks and special pavement" in the area in front of
the relocated Lane Bryant and Catherine's retail spaces. The landscaping plan shows the landscaping, but
none of the plans show the other features. Please add these features to the civil and landscaping plans.
6. Condition #12 of the land use approval for this project requires that prior to C of O for the new
addition, landscaping shall be installed along the south property line within the BPA easement, pursuant to
the March 10, 2011 city letter under file # 11-100963 (enclosed). This landscaping should be added to the
landscaping plan.
7. The size of some of the landscaping islands have changed from the preliminary landscaping plan
approved with the land use decision. It seems that the area is increased on the north side of the site and
decreased on the south side. The notes on sheet L2.0 regarding calculation of required square footage do
not seem to have changed. Please confirm that these calculations are still correct.
Please include, with revised plans, a short written summary identifying how these comments have been
addressed.
CITY OF
4�. Federal Way
DATE: December 6, 2012
TO: Isaac Conlen
Gordy Goodsell
FROM: Kevin Peterson
SUBJECT: KOHLS - (12-105369-00-EN)
2001 S 320TH ST
MEMORANDUM
Public Works Department
Attached are plans for the site development in preparation for the new Kohl's store, with associated parking
lot redevelopment.
Note that they are showing existing building demolition on these plans, however, they will need to get a
separate demolition permit for that actual work.
Isaac- there are some landscape plans at the back of the plan set.
Gordy — this is mostly an FYI for fire, as they are showing some fire lines that they are proposing for
demolition. I think the fire line demo should be associated with the future building demolition.
I will attempt to get some kind of schedule from Steadfast as to how they intend on proceeding with the
entire project (demo old, build new), and will forward that on when I get it.
CIT
Federal Way
City of Federal Way • Public Works Department
33325 Eighth Avenue South • Federal Way, WA 98003-6325
Phone 253-835-2700 • Fax 253-835-2709 • www. E ffederalwa .com
LETTER OF TRANSMITTAL
Date: February 4, 2013
To: Fred Brown, P.E.
ESM Consulting Engineers
33400 8th Ave South, Ste# 205
Federal Way, WA 98003
RE: Kohl's at The Commons site Development
From: Kevin Peterson
Engineering Plans Reviewer
(253) 835-2734
TRANSMITTED AS CHECKED BELOW:
❑ For Your Review ❑ As Requested
❑ For Your Approval ❑ For Your Information
® For Your Action ❑ Under Separate Cover
i
1 Approved mylars
I
COMMENTS:
®
Please Return
❑
Other
❑
via
Please make 4 copies of the approved plans and return them to me (including the mylars) at your earliest
convenience.
cc: Project File
Day File
RES U M ITf ffbRTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
Federal Way, WA 98003-6325
CITY OF '+�= JAN 1 i 2013 253-835-2607; Fax 253-835-2609
Way ww��.ritvofFedorahtay.ramFedera
CITY OF FEDERAL WAY
CDS
RESUBMITTAL INFORMATION
This completed form MUST accompany all resubmittals.
—pleasenote.- Additional or revised plans or documents for an active project will not be accepted
unless accompanied by this completed form. Mailed resubmittals that do not include this form or that
do not contain the correct number of copies will be returned or discarded. You are encouraged to
submit all items in person and to contact the Permit Counter prior to submitting ifyou are not sure
about the number of copies required. **
ANY CHANGES TO DRAWINGS MUST BE CLOUDED.
Project Number: / 2- - G' *y- -- �-- . � -
Project Name: 's
Project Address:
Project Contact: ,,� _ Phone:
RESUBMITTED ITEMS:
# of Copies **
rA
Detailed Description of Item
** Always submit the same number of copies as required foryour initial application.**
Resubmittal Requested by : r e�!"17 11 sett r Dated: iz / z� / z
ern er
OFFICE USE ONL
IY
Distribution Date: �7
h,.
# I r ❑E
Fire
Other
Bulletin #129 —January 1, 2011 Page 1 of 1 k:\Handouts\Resubmittal Infonnation
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
�r RESUBMITTED 33325 8`h Avenue South
Federal Way, WA 98003-6325
CITY OF Way
253-835-2607; Fax 253-835-2609
FederalIAN 11 2013 www.Ci1yoffgderalway.rorn
CITY OF FEDERAL WAY
CDS
RESUBMITTAL INFORMATION
This completed form MUST accompany all resubmittals.
"Please note: Additional or revised plans or documents for an active project will not be accepted
unless accompanied by this completed form. Mailed resubmittals that do not include this form or that
do not contain the correct number of copies will be returned or discarded. You are encouraged to
submit a# items in person and to contact the Permit Counter prior to submitting if you are not sure
about the number of copies required. **
ANY CHANGES TO DRAWINGS MUST BE CLOUDED.
Project Number:-
1
Project Name:
Project Address: L2E t2na ,t
Project Contact: r� ���V Phone: Z 53✓ g 3� —�O �3
RESUBMITTED ITEMS:
# of Copies **
Detailed Description of Item
IL
** Always submit the same number of copies as required foryour initial application.**
Resubmittal Requested by: _Ll I� ��— Letter Dated- '
0@0 member)
J OFFICE USE ONL
RESUB #.- Distribution Date:
Dept/Div
Name
#
Description
Building
Plannin
PW
Fire
Other
Bulletin #129 —January 1, 2011 Page I of 1 k:\Handouts\Resubmittal Information
RES U B M I� MENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
��. Federal Way, WA 98003-6325
CITY of JAN 0 4 2012 253-835-2607; Fax 253-835-2609
Federal Way
CITY OF FEDERAL WAY www.citvoffederalway.com
CDS
RESUBMITTAL INFORMATION
This completed form MUS T accompany all resubmittals.
'Please note: Additional or revised plans or documents for an active project will not be accepted
unless accompanied by this completed form. Mailed resubmittals that do not include this form or that
do not contain the correct number of copies will be returned or discarded. You are encouraged to
submit a# items in person and to contact the Permit Counter prior to submitting ifyou are not sure
about the number of copies required. **
ANY CHANGES TO DRAWINGS MUST BE CL OUDED.
Project Number: I a - ! '.0 S 3 -F - 11) U - 7_ /�)
Project Name: k, 'S
Project Address:
Project Contact: r.
RESUBMITTED ITEMS:
Phone: z S3 • 8 39 . /, //
# of Copies "'
Detailed Description of Item
** Always submit the same number of copies as required foryour initial application.
Resubmittal Requested by
RESUB #.- l/
Dept/Div Name
Building
Planning
PW
Fire
Other
K. Letter Dated: lz-
(staft menlDer
OFFICE USE OK Y _
Distribution Date: 14 6g By.'
# I Description
Bulletin #129 —January], 2011 Page 1 of 1 k:\Handouts\Resubmittal Information
.SIC Ra D® D02/13/2011ATE 3 )
� CERTIF��ATE OF LIABILITY INSU► __ ONCE
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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.
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certificate holder in lieu of such endorsement(s).
PRODUCER LIC 40726293 1-415-391-1500 CONTACT
-NAME:
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Arthur J. Gallagher & Co. Insurance Brokers of CA Inc_ AIC Nol-
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SUSI�
Policy NUMBER
MM )D�
MMIDDIYY OLICY EXP
LIMITS
A
GENERAL LIABILITY
X
X
GLO2979135-11
02/01/1
11/01/13
EACH OCCURRENCE
S2,000,000
AMA D
PREM orcuuemal
$300,000
X COMMERCIAL G£NERALLIABILITY
I
MED EXP (Any one person)
$ 10,000
I CLAIMS -MADE [�] OCCUR
]
PERSONAL& AOV INJURY
$ 2,000,000
j
GENERAL AGGREGATE
$ 4,000,000
GENIAGGR£GATELIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG
$4,000,000
$
POLICY X PR LOC
A
AUTOMOBILE LIABILITY
X
X
BAP2979136-11
01 1
11/01/13
COMBI161ay4 nill L LIMIT
1,000,000
BODILY INJURY (Per person)
$
X
ANY AUTO
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
PROPERTY DAMAGE
P peddontl
$
X HIRED AUTOS X AUTOS
$
B
X
UMBRELLA LIAS
X
OCCUR
G22015357007
02/01/1
11/01/13
EACH OCCURRENCE
s 10,000,000
AGGREGATE
$ 10, 000, 000
EXCESS LIAB
CLAIMS -MADE
DED I X RETENTION$ 10, 000
$
A
WORKERS COMPENSATION
WC3504591-12 (Stop Gap)
11/01/1
11/01/13
X WCSTATU- OTH-
E.L. EACH ACCIDENT
$ 1,000,000
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - EA EMPLOYE
$ 11000,000
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
N I A
E.L. DISEASE -POLICY LIMIT
$ 1, 000, 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
S.D. Deacon Job #010063 / RE: The Commons Kohls
ADDITIONAL INSURED(S): Steadfast Commercial Properties, its members, managers, directors, officers, employees, agents,
affiliates, successors, assigns, any lender and any other parties as stipulated by Owner; Commons Mall, LLC;
Steadfast Commercial Management Co., Inc.; EvCom Holdings, LLC; Lakehaven Utility District;
Bank of America, N.A.; City of Federal Way
UrK I il-IL.A I t NUILUMIN
S.D. Deacon Job #010063 / RE: The Commons Kohls
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Bank of America, N.A. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CREB Collateral Administration Insurance Group ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN: Karen Lineberry
Mail Code: FL9-100-03-26 AUTHORIZED REPRESENTATIVE
P.O. Box 4039
JacksonvilI le, FL 32203-0329 / c Z(
USA
U 1!JdB-ZU1U AUUKU L;UKYUKAI Ivry. An rlgn1S reserveu.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
ranshargcs
31998300
i
Additional Insured — Automatic — Owners, Lessees OrZURICH
Contractors
Policy No.
Exp Date of Pol. Eff. Date of End.
Agency No. Addl. Prem. Return Prem.
GL02979135-11
11-01-13 02-01-13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named insured: S.D. Deacon Corp. of Washington
Address (including ZIP Code):
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section H — Who Is An Insured is amended to include as an insured any person or organization who you are re-
quired to add as an additional insured on this policy under a written contract or written agreement.
B. The insurance provided to the additional insured person or organization applies only to "bodily injury', "property
damage" or "personal and advertising injury' covered under SECTION I - Coverage A - Bodily Injury And
Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, 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; and resulting directly from:
a. Your ongoing operations performed for the additional insured, which is the subject of the written con-
tract or written agreement; or
b. "Your work' completed as included in the "products -completed operations hazard", performed for the
additional insured, which is the subject of the written contract or written agreement.
C. However, regardless of the provisions of paragraphs A. and B. above:
1. We will not extend any insurance coverage to any additional insured person or organization:
a. That is not provided to you in this policy; or
b. That is any broader coverage than you are required to provide to the additional insured person or or-
ganization in the written contract or written agreement; and
2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the
lower of
a. The Limits of Insurance provided to you in this policy; or
b. The Limits of Insurance you are required to provide in the written contract or written agreement.
Includes copyrighted material oflnsurance Services Office, Inc., with its permission, U-GL-1175-B CW (3/2(K)7)
Pagel oft
D. The insurance provided to the additional insured person or organization does not apply to:
"Bodily injury', "property damage" or "personal and advertising injury' arising out of the rendering or failure to
render any professional architectural, engineering or surveying services including:
1. The preparing, approving or tailing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; and
2. Supervisory, inspection, architectural or engineering activities.
E. The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request For defense and indemnity of the claim or "suit' will promptly be brought against any policy issued
by another insurer under which the additional insured may be an insured in any capacity. This provision
does not apply to insurance on which the additional insured is a Named Insured, if the written contract or
written agreement requires that this coverage be primary and non-contributory.
F. For the coverage provided by this endorsement:
1. The following paragraph is added to Paragraph Ca. of the Other Insurance Condition of Section TV —
Commercial General Liability Conditions:
This insurance is primary insurance as respects our coverage to the additional insured person or organiza-
tion, where the written contract or written agreement requires that this insurance be primary and non-
contributory. In that event, we will not seek contribution from any other insurance policy available to the
additional insured on which the additional insured person or organization is a Named Insured,
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV —
Commemial General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an addi-
tional insured, in which the additional insured on our policy is also covered as an additional insured by at-
tachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit".
This provision does not apply to any policy in which the additional insured is a Named Insured on such other
policy and where our policy is required by written contract or written agreement to provide coverage to the
additional insured on a primary and non-contributory basis.
G. This endorsement does not apply to an additional insured which has been added to this policy by an endorse-
ment showing the additional insured in a Schedule of additional insureds, and which endorsement applies spe-
ci fically to that identified additional insured.
Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply
as written.
Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-GL-1175 B CW W2007)
Page 2 of 2
Named Insured: S.D. Deacon Corp. of Washington
POLICY NUMBER: GL02979135-11 COMMERCIAL GENERAL LIABILITY
CG 24 0410 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
ANY PERSON OR ORGANIZATION THAT REQUIRES YOU TO WAIVE YOUR
RIGHTS OF RECOVERY, IN A WRITTEN CONTRACT OR AGREEMENT WITH
THE NAMED INSURED THAT IS EXECUTED PRIOR TO THE ACCIDENT OR
LOSS.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV —COMMERCIAL
GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we matte For injury or damage arising out of your ongoing operations or your work" done
under a contract with that person or organization and included in the 'products -completed operations hazard",
This waiver applies only to the person or organization shown in the Schedule above.
CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑
Notification to Others of Cancellation
ZURICH
Policy No.
Eff. Date of Pol
Exp. Date of Pol.
Eff. Date of End
Producer No.
Add'I. Prem
Return Prem.
GLO2979135-11
02/01/13
11/01/13
02/01/13
09109000
N/A
N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
Liquor Liability Coverage Part
Products/Completed Operations Liability Coverage Part
A. If we cancel this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment
of premium, we will mail or deliver a copy of such written notice of cancellation:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured,
or the longer number of days notice if indicated in the Schedule below.
B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will
mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or
organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of
such notice.
SCHEDULE
Name and Address of Other Person(s) /
Or anization s :
Any person or organization with whom you have
reed through written contract, agreement or ep rmit_
All other terms and conditions of this policy remain unchanged.
Number of Days Notice:
60
U-GL-1446-A CW (06110)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
WAIVER OF TRANSFER F RlGHO OF RECOVERY AGAINST OTH ER& TO US
THIS ENDORSEMENT CHANGES TUC POLICY. PLEASE READ IT CAREFULLY.
POLICY NO. EFF. DATE OF POL. I EXP. DATE OF POL. I EFF.DATE OF END, I AGENCY NO. I ADDL. PRG:N I RETURN FREW
BAP2979136-11 11/01/2012 ' 11/01/2013 11/01/2012
Named insured S.D. Deacon corp. of Washington
Address (Including ZIP Code)
This endorsement modifies insurance provided by the following:
Business Auto Coverage Part
Truckers Coverage Part
Garage Coverage Part
SCHEDULE
Name of Person or Organization:
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN
CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER
THIS POLICY,
We Nvahe any right of recovery we muy have against the designated person or organization shown in the schedule beeausc of
payments we make ibr injury or damage caused by an "accident" or "lus9' rosulting from the ownership, maintenance, or use eF a
covorod "auto" for which a Waiver of Subrogation is required in conjunction with work performed by you for the designated
person or organization, The waiver applies only to the designated person or organization shown in the schedule.
Countersigned
iJ-CA-320-A (CW) (4/92)
POLICY NUMBER: BAP2979136-11
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by
this endorsement.
This endorsement identifies person(s) or organization(s) who are'insureds" under the Who Is An Insured Provision of
the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inceptlon date of the policy unless another date is indicated
below.
Endorsement Effective: 11/01/2012 1Countersiged By:
Named Insured: S.D. Deacon Corp. of Washington
SCHEDULE
Nam of Person(s) or Organization(s):
ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED, THROUGH WRITTEN
CONTRACT, AGREEMENT OR PERMIT, EXECUTED PRIOR TO THE LOSS, TO PROVIDE
ADDITIONAL INSURED COVERAGE.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for liability Coverage, but only to the extent that
person or organization qualifies as an "insured" under the Who Is An Insured Provision contained In Sectlon II of the
Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 13
Notification to Others of Cancellation
ZURICH
Policy No. Eff. Date of Pol.
Exp. Date of Pol.
Eff. Date of End.
Producer No. Add'I. Prem
Return Prem.
BAP2979136-11 11/01/12
11/01/13
11/01/12
09109000 N/A
N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial Automobile Coverage Part
A. If we cancel this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of
premium, we will mail or deliver a copy of such written notice of cancellation:
1. To the name and address corresponding to each person or organization shown in the Schedule below; and
2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured,
or the longer number of days notice if indicated in the Schedule below.
B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail
or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or
organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of
such notice.
SCHEDULE
Name and Address of Other Person(s) / Number of Days Notice:
Organizations :
Any person or organization with whom you have 60
reed through written contract, agreement or permit
I
I
All other terms and conditions of this policy remain unchanged.
U-CA-812-A CW (05110)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 33
NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT
This endorsement is used to add the following to Part Six of the policy.
PART SIX
CONDITIONS
A. If we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will
mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each
person or organization shown in the Schedule below. Notification to such person or organization will be
provided at least 10 days prior to the effective date of the cancellation, as advised in our notice to you, or the
longer number of days notice if indicated in the Schedule below.
B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of
such written notice of cancellation to the name and address corresponding to each person or organization
shown in the Schedule below at least 10 days prior to the effective date of such cancellation.
C. If notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient
proof of such notice.
SCHEDULE
Name and Address of Other Person(s) / INumber of Days Notice:
Or anization s �
Any person or organization with whom you have 60
agreed through written contract, agreement or permit
All other terms and conditions of this policy remain unchanged.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 11/01/.12 _ Policy No. WC3504591-12 Endorsement No.
Insured S.D. Deacon Corp. of Washington Premium $
Insurance Company Zurich American Insurance Company
WC 99 06 33
(Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission.
Page 1 of 1
All other terms and conditions of this policy remain unchanged.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 11/01/.12 _ Policy No. WC3504591-12 Endorsement No.
Insured S.D. Deacon Corp. of Washington Premium $
Insurance Company Zurich American Insurance Company
WC 99 06 33
(Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission.
Page 1 of 1
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
02/13/2013
NAME OF INSURED: S. D. Deacon Corp. of Washington
Additional Description of Q erations/Re arks fcom Pa 1:
Additional information:
General Liability:
*Blanket Additional Insured per endorsement Form no_ U-GL-1175-B CW (3/2007)
*Primary Non Contributory when required by written contract Form U-GL-1175-B CW (3/2007)
*Waiver of Subrogation when required by written contract Form CG24 04 10 93
Automobile Liability:
*Blanket Additional Insured per endorsement Form no. CA 20 48 02 99
*Waiver of Subrogation when required by written contract Form U-CA-320-A (CW) (4/92)
Umbrella/Excess:
Excess coverage follows primary policies, subject to policy terms, conditions and exclusions.
SUPP