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AG 96-200 D;T~I'~~I<:)lt? ¡DAZ,E ïj~T' h REI;!UEST FOR r~~ ~er \ CITY OF FEDERAL WAY LAW DEPARTMENT CONTRACT PREPARATION/DoCUMENT REVIEW/SIGNATURE ROUTING SLIP 1. ORIGINATING DEPT./DIV.:~i.J.b\l~ I¡)O r Ii...- 2. ORIGINATING STA.-.- PERSCN: -=,) ~ \J Q/'VV'U .- ÛeÙe..loprnc,,^ß .s..o(U7~ EXT: 41 z.;-3. DATE REQ. By: JQj 1:;..( 9 (0 4. TYPE 10.- DecuMENT REIOUESTEe (CHECK lONE): 0 PRe.-USIDNAL SERVICES AGREEMENT 0 MAINTENANcE/LAseR AGREEMENT 0 PUBLIC WeRKS CeNTRACT 0 SMALL PUBLIC WeRKS CeNTRACT ILc.. TNAN "',CCCI ~~ cnn.....~ IE.D., AD.CC.CNT . PC..,MAON BONO' ..ODN.ENT O. 'UND. ON LOEU D. BOND' 0 CeNTRACTeR BELECTleN eeCUMENT 'C.D.. R'B, R.-P, R'.' 0 PURCHABE AGREEMENT IMA".'AL., BU""LOU. -."".CNTI 0 REAL ESTATE PURCHASE & SALES AGREEMENT 0 CCNTRACT AMENDMENT 0 EASEMENT 0 OTHER AG#: 5. PRO.JECT NAME: L::L~ 6. NAME OF' CONTRACTOR: O~c.!L ~\ dcð- BL..a=i(~. 003tn ADDRESS: PHCNE: TYPE 10.- PERseN lOR ENTITY {CHECK lONE}: 0 INelvleuAL 0 PARTNERSHIP 0 SeLE PRePRIETCRSHIP STATE: 0 CeRPeRATleN TAX le#¡ss#: SIGNATURE NAME: TITLE: 7. SCOPE OF' WORK: ATTACH EXHISIT A' A CCMPLETE AND DETAILEe eESCRIPTleN 10.- THE SERVICES lOR scePE 10.- weRK, INCLUDING CCMPLETICN OATES .-1010 EACH PHASE 10.- WCRK AND LeCATICN 10.- weRK. B. TERM: COMMENCEMENT OATE: CCMPLETleN DATE: 9. TOTAL COMPENSATION: $ {INCLUDES EXPENSES AND SALES TAX, IF" ANYI 110 DALCU~TCO CN NOU.LT ~.c. CNA.DE - AmCN .CNEDULU D' C."LOVU. TOTLU ANO NOU.LT _TU' REIMBURSABLE EXPENSES: DYES DNc IF" YES, MAXIMUM eCLLAR AMCUNT: $ Is SALES TAX OWED? 0 YES 0 Nc IF" YES, $ PAle SY: 0 CeNTRACTeR DeITY 1 O. SELECTICN PRCCESS USED (CHECK lONE): 0 RE,>UEST .-eR BIDS 0 REQUEST .-eR PRePDSALS 0 RE,>UEST .-cR QUCTES 0 RE,>UEST .-cR QUALIF"ICATICNS 0 ARCHITECT & ENGINEER UST 0 SMALL WORKS ReSTER 1 1. CONTRACT REVIEW 0 RISK MANAGEMENT Ò' I~A~DAT~h~ì1D6 0 CIRECTCR ~(ALL ceNTRACTS) <ALL CONT_CTO EXOEPT A.CNO.ENTO, OONT_OTO. 8ELCOTOON OOOU.EN" 0 PURCHASING 1 2. CONTRACT SIGNATURE ROUTING INITIAUOATE ApPReVEe 0 LAW DEPARTMENT J!I CITY MANAGER ~y CLERK ~:~GS~::E:C:: S:Cq~-?¡¡ff'NGifl¡v 0 PURCHASING: PLEASE CHARGE Te: 7/1 .PI 9' (" r¡; VtV COMMENTS a 1{,!t ~ J tl J\ -h(/nLJ r!c:Lb ~ r2 I ""----. WH'TE - C.'"'NAL sTA" WITH COHT.ACT CANARY mo" TO DW, P'NK. LAW cm. GCLCENRCC - Oo'D'NATON" STA.. LC49. IR<v .09" AS q ft;-arP Applicant: Cary Lang Construction, Inc. Project: Lang Office Building Property Address: 34618 11 th Place South Federal Way, WA 98003 Bond #: 511-IV'/' - '13q I Permit#: BLD 96-0036 Bond Amount: $32,463.00 Cash Deposit Amount: $1,298.00 CITY OF FEDERAL WAY AGREEMENT AND PERFORMANCE/MAINTENANCE BOND THIS AGREEMENT ("Agreement") is dated effective this 13th day of June, 1996. The parties ("Parties") to this Agreement are the City of Federal Way, a Washington municipal corporation ("City") and Cary Lang Construction, Inc., a Washington corporation ("Applicant"). A. The Applicant is required to perform certain work and/or complete certain improvements, including providing a paved access, parking, and a drainage system at the above referenced address located in Federal Way, Washington in connection with Applicant's Land Use Application under the above- referenced permit number ("Permit"); B. The improvements will be constructed or the work performed in accordance with record drawings and approved plans on file with the City ("Plans"); C. The City has determined that the Applicant must post security with the City pursuant to Sections 22-146 through 22-159 of the Federal Way City Code ("FWCC") as now existing or hereafter adopted or amended, to guarantee Applicant's performance of the required construction of improvements or performance of work, maintenance or repair in accordance with the Plans as a condition of granting the Permit. NOW, THEREFORE, the Parties agree as follows: 1. Imorovements. Applicant shall construct all improvements and perform all maintenance pursuant to the Plans, to the City's satisfaction ("Work"). The obligation to maintain the improvements shall continue for a period of two (2) years after issuance of the certificate of occupancy or final inspection, or such longer period as required by the FWCC or other applicable law, rule or regulation. 2. Comoletion of Work. The Applicant shall complete the Work to the City's satisfaction, within the time period prescribed by the City, and in full compliance with the Plans, including any approved amendments thereto, and in conformance with all applicable laws, rules or regulations. 3. Performance/Maintenance Bond. Applicant shall deliver the fully executed Performance/ Maintenance Bond to the City in the form attached hereto as Exhibit "A" and incorporated by this reference ("Bond"), to guarantee Applicant's performance of the construction of the improvements and/or maintenance of the improvements pursuant to the Plans. 4. Release of Bond. If the Principal constructs the improvements in accordance with the terms of the Bond, the Permit and all applicable law, the sum of the Bond shall be reduced by seventy percent (70%) after final inspection and approval of the improvements by the City and the City will deliver to Principal the fully executed Partial Release of Bond attached hereto as Exhibit "B". Except as set forth in the preceding sentence, the Bond shall remain in full force and effect. That portion of the Bond equal to ORIGINAL thirty percent (30%) of the original penal sum shall remain in full foræ and effect for two (2) years after final inspection and approval, as a maintenance bond to guarantee against defective materials and workmanship in the construction of the improvements and to insure continued maintenance of the improvements. Two (2) years after final inspection and approval of the improvements and performance of the maintenance, the City will release the remaining portion of the Bond by executing and delivering to Principal the Full Release of Bond attached hereto as Exhibit "C". 5. Riaht to ComDlete Work. In the event the Applicant fails to perform the Work, the City may, but in no event is it obligated to, request the disbursement of the Bond from the surety and perform any of the necessary Work. Upon demand, Applicant agrees to pay the City an amount equal to all of the City's costs and expenses in performing such Work in excess of the amount of the Bond. 6. ~. The Community Development Department of the City shall be given forty-eight (48) hours notice prior to the commencement of the Work. 7. Indemnification. Applicant agrees to indemnify and hold the City, its elected officials, officers, employees, agents, and volunteers harmless from any and all claims, demands, losses, actions and liabilities (including costs and attorney fees) arising from, resulting, or connected with this Agreement and the Bond, including without limitation, the City's performance of the Work pursuant to Section 5 herein. 8. Administrative Cash DeDosit. In addition to the amount of the Bond, Applicant agrees to pay a cash deposit to the City pursuant to Section 22-151 of the FWCC, upon the execution of this Agreement equal to the following percentages of the amount of the Bond: Amount of Bond Amount of Cash DeDosit Up to $20,000 $20,001 - $50,000 $50,001 - $100,000 $100,001 and up 5% of Bond (minimum $100) 4% of Bond 3% of Bond 2-1/2% of Bond The cash deposit may be used by the City to cover its actual expenses in administering this Agreement and, if necessary, collecting and using the proceeds from the Bond. 9. Remedies Cumulative. No remedy provided for by this Agreement shall be deemed exclusive, but shall be deemed cumulative and in addition to every other remedy available to the City at law, in equity or by statute. Applicant's liability under this Agreement is not limited to the amount of the Bond. 10. ~. Applicant shall record a license in the form attached hereto as Exhibit "0" and incorporated herein by this reference with the King County Department of Records, immediately upon the execution of this Agreement and at Applicant's cost. 11. General Provisions. This Agreement may not be amended except by written agreement signed by the Parties. Any provision of this Agreement which is declared invalid, shall not invalidate the remaining provisions of this Agreement. The failure or delay of the City to declare any breach or default -2- shall not waive such breach or default. This Agreement may not be assigned by any Party without the written consent of the other Party. This Agreement shall be binding upon and insure to the benefit of the Parties' successors in interest. Time is of the essence. GARY LA~STRUCTION' INC By: ~ 11 ¿ ---:£ tJ/'pÇ' - I 30117 17th Avenue SW Federal Way, WA 98023 (206) 661-6880 ,~ Its: CITY OF FEDERAL WAY By: ~ Ò ~ fJ1 Kenneth E. Nyberg, City Manager 33530 1 st Way South Federal Way, WA 98003 >;n:s~ City Clerk, N. Christine Green, CMC APPROVED AS TO FORM: ,,~t)~ ell, City Attorney ',Iboo',"oo,.bo' 6- 7-96 196-219) -3- EXHIBIT B PARTIAL RELEASE OF BOND # The undersigned hereby acknowledges that a portion of the conditions of the Agreement and Performance/Maintenance Bond for Lang Office Building, BLD 96-0036, have been satisfied and hereby authorizes the release of an amount equal to Twenty-Two Thousand, Seven Hundred Twenty-Four and no/100 Dollars ($22,724.00). The remaining funds equaling thirty (30%) of the cost of the work or improvements shall be retained by the City for a period of two (2) years as security for Assignor's performance of all maintenance for the above described project and as a guarantee against defective materials or workmanship in the construction and maintenance of such improvements. DATED this day of ,199_. CITY OF FEDERAL WAY By: (Name, Title) EXHIBIT C FUll RELEASE OF BOND # TERMINATION OF LICENSE The undersigned hereby acknowledges that the two (2) year maintenance period has expired, that the work or improvements covered by the Agreement and Performance/ Maintenance Bond for Lang Office Building, BLD 96-0036, have been completed to the City's satisfaction and that the City is not aware of any defect in workmanship or materials. Accordingly, the undersigned hereby releases the sum of Nine Thousand, Seven Hundred Thirty- Nine and no/1 00 Dollars ($9,739.00). The undersigned further releases all right, title and interest granted to the undersigned by reason of a certain License Agreement recorded under King County Recording No. ("license Agreement") and acknowledges that all obligations and rights contained in the License Agreement are hereby terminated. DATED this day of .19_. CITY OF FEDERAL WAY By: (Name, Title) BOND NO: SA1424391 EXWIBrr A Pro~ L...g Oflleo Buldlng Pe..,,;t ø,BLD 88-00. CITY OF FEDERAL WAY PERFORMANCEIMAINTENANCE BOND KNOW AlL PEOPlE BY THESE PRESENTS: We. the undersigned. Cary Lang Construction. Inc.. as øril'lciø81 (°Pril'lciø""). al'ld STAR INSURANCE COMPANY, the undersigned corpora1ion organi~ad end existing uoder the laws of tile 5181:" '!If MICHIGAN and legally doing business in the State of Wøshington as a surety (.Surety"l. ... held and firmly bound unto the City of Fedaral WIlY. . Washington municipal corporation ("City") In Iha pa...1 ...m of Thirty-Two Thousand. Four Hundred Sixty-Three and 1'101100 Donais 1'32,463.001 for the payment of whicl1 they firmly bind them"....s and their Ieu/ot represent";",,". "ucc...ora and anigns, jointly and severally. Th~ Qbligetion is an.rad into In pursuant to tRe statutes of the State of Washington and tlie ordinanc... regulation$. standards and poUcies of the City. as now existing <>r her"=ft~r .manded Dr adopted. The Principal has entered into an Agreement with the City of even date 10 provided a pBVl d ac:œss. parking. and a drain¡¡ge system at 34618 11 th Place South, Faderal Way. W8shìng~. in connection with Federal Way Permit' BLD 96-0038. NOW, T¡'¡¡;A~RE, if the Principal shaH perform all the provisions of the Agreement in I~e maMer ønd within the time period presaibed by the City, Dr within StIch axtenSÎons of rime ~ mav be Wlnted under W: Agreement, and shall pay aIIlaløl!f:$, rneØ1aniC$. subcantraaors' and mefa,ill ...... or women. end all persons who shall supply the Prinåpal or subcontractors with provisions and IKIJIplies fw the carrying on of said work, and shall hold the City, their officlal~. ageng. employees and IlCklmeers I'I8tmIess from Bny loss or damage occasioned 10 any Plrsc¡n or property by re85On of any c..-elcssness or negligence on the part of the PrincipBI, or -"y subco"nctor in the peñrJrman~ of s8id work, and sItaIl indamÑfy and hold the Ciry h1lfTl11e$s from any damage or ex¡JeASl! by reæon of f1IifuN! of PIlffamaIlCll as !I IeCifI8d in the AgreemerAr. or from d8f_1IpPIKIrÏnIJ or dBwIoping in thø matBrial or workmen5hip provided Or perform~d under the Agreemenl wõthin a period of tWO (21 years after ita fjl\lll aGœptance thereof by the City, then and in the event this obtigation shall be void; but otherwise. it shan be 100 ramaln In fun force and effect. And the Surety, for value received, hereby further litipulates and agrees that no chang!" extension of time. alteration or addition to the terms of the Agreement or 10 the work to lie perfonnød ~nder or the specifications accompanying the 5ame shIll In any way affect its obligati<:ln on this bond. and il d08S hereby waive notice of any change, extension of tim~. alterations or additions to the terms of the Agreemanl or 10 the WDfk. The $urety hereby agrees that mødifications and changes may be made in the terms end provillÎ""" of the Agræment without natice to Surety, and any 1IUch modifications or chang~s IncreasIng the IOtal amount 10 be paid the Principal shall automatically inc:ruq the ob!ìgatiQn of the Surety on tI>ia I'IIrfoomaMeliond in a fike amount, such incn:aa8. no_ver, not to exce.d twenty-five perœnt (25%1 of the original amount of thïa bond without the consent of the Surety . BO~~ NO: SA1424391 Within forty-five (451 dayS of receiving notic. that tn!! Prineip.1 has defauhlld on aU Of part of the tem'IS of tile Agreement, the S.....ty shall make a written convnitment to the City that it ..ìÐ either: (8) cure the default Itself within a fuson.ble time period, or Ihl tender to the City, ttlt amount n«usury for the CitY U) remedy tho default, including legal fees incurred by tn.. City, or 0 in tile event thlt Surety'" evalu.tion of the diapute is not çompJete or in the event the Surety disPUtea the City's çl8Ìffi of dcf....lt. the Surety shell notify the City of its finding and its intent. if any. to Interplead. TnB Sursty shall then fulfin ita obtigationa under thi$ bond~ accotcling to the option It has electlld. Should Surety elec:t option la) to cure the default, the penal sum of the Bond shell be rllduced In In iItT1ount eQU81 to the coats actually incurred bt the Surety in cuting the default. If the Surety !!leCts option (bl. then upon c:ompletion of thè necessary wo"". the City &NO notify the SuretY of in eetu" coats. The City shall rBtUni. without interest, any overpayment made by the Surety and tile Surety .shall paV to the City any BetU'! (CSU which exceed the City ea1lmete. limited U) the bond amount. Should the Sul1Ity elect option Ie), the Parties shaD first complete partiçipation in mediation. described in the below paragraph, !fiat to any Interplead .[¡tion. In the event 8 dispute should arise between the Parties to this Bond with respect U) the City's dederetion of default by the Princ;ipal. the Parties agree to partiCip8te in It !em four hours <1f mediation in ecc:!lfdanc8 wi1h the madiatì!ln pf"eadures of United States Arbitra1lon ~ Mediation C.USA&M"Þ. TIle Parti8s shall proportionlltely sh.e in Ihe cost of tile mediation. The mecliø6on shaM be administered bV die Se.ttle USA""" office. 4300 Two Union Square:. 601 Union Strllet. Seattle. Washington 98101-2327. The Surety sh811 not interp"8d prior tØ completion of the mediation. DATEO this Jú- day of ~ -' 19sØ. CORi'OftATE S'E'Äl OF PRINCIPAl, CARY LANG 1:0NSTRUCl10tI. INC. By: '?rJ jJ~ n Executing Bond I~; 30117 , 7th AvenueSW Federal Wav. WA 98023 (2OÐ) 661-Q80 CORPORATE SEAL OF SURETY: STAR INSURANCE COMPANY BY: TITLE: ~¿;';~~'\<2--) é/ ¿';J¿~..:-c-' J S C. ERLEWINE, ATTORNEY IN FACT APPROVED AS TO EœM : . ~ Cìc-.-- -2- indell, City Attorney ~TAR INSURANCE CO,,-uANY GENERAL POWER OF ATTORNEY NO. SA 14 2 4 3 91 (Void unless numbered in red) KNOW ALL MEN BY THESE PRESENTS. that Star In,urance Company ha, made, con"ituted and appointed, and by {hm pte"nls docs make, con"itute and appoint JAMES C. ERLEWINE OF SEATTLE, WASHINGTON ils true and lawful attomey-in-Iact, for it and in it, name, place, and stead to execute on behalf of the said Company, as surely, bonds, undertakings and contracls or suretyship to be given to Applicable to All Obligees provided that no bond or undertaking or contract of sutetyship executed IOnder this authroity shall excced in amolOnt the sum of two million five hundred thousand ($2,500,000.00) dollars. This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of {he following Reso]ution adopted by the Board ofDitectors of the Company on the 7th day of January, ]993. "RESOLVED, that thc Chairman of the Board, the Vice Chairman of the Board, the Ptesident, an Executive Vice Pte,ident or a Seni", Vice Ptesident or a Vice Ptesident of the Company be, and that each or any oflhem is, authorized to execlOte Powers of Altorney qualifYing the attorney-in-fact named in the given Power of Attomey to execute in hehalf of the Company bonds, undertakings and all contracts of surctyship; and that an Assi"ant Vice Ptesident, a Sectetary or an Assis{ant Sectetary be, and that each or any of them herehy is, authorized to atte,t the execution of any ,uch Power of Attorncy, and to attach theteto the "a] ofthe Company. FURTHER RESOLVED, {hat the ,ignaturcs of such officers and the "al of the Company may bc affixed to any slOch Power of Attorney or to any certificate telating theteto by facsimile, and any such Power of Attorney or certit;cate bearing ,uch facsimik signaturos nr facsimile "al shall be valid and binding upon the Company when '0 affixed and in the futute with respect to any bond, undertaking or conlract of ,utety,hip tn which it is attached." IN WITNESS WHEREOF, STAR INSURANCE COMPANY h" cau"d ils offici a] ,ea] to be heteunto affixed, and thesc pte"nt, to be ,igned by one of ils Senior Vice Pte,idenls and attested by one of its Assistant Vice Pte,ident, {his 13th day of March, 1995. COUNTY OF OAKLAND On thi, 13th day of March, ]995, befote me pe"onally came Marc S. Willner, to me known, who being by me duly 'wurn, did depn" and 'ay that he is a Senior Vice Pte,ident of STAR INSURANCE COMPANY, the corporation dmribed in and which executed the above in"rument; that he knows the ,ea] ofthe "id corporation; thai the "a] affixed to the said i"'trlOment is ,uch corporate "a]; that it wa, '0 affixed by order of the Board of Ditecto" of said corporation and that he ,igned his name thereto by like order. COIJ.EEN KELTZ Nobly NIfIc, Oakland CtuIIy, MI My CommIssion ExpiÆlS Apr, 30, 1999 I, Ihe unde"igned, of STAR INSURANCE COMPANY, a Michigan corporation, DO HEREBY CERTIFY that the fotegoing and attached Power of AUomey temain, in full focee and h" not been tevoked; and furthermote {hat the Reso]ution of the Board of Ditecto", "t torth in the said Power of Attorney, i, now in force d-- ""'"~-""""""""'""""H~"'M"','" ~"'M M '"~r ~ Mary Jo laUd, Assistant Secretary CERTIFICATE 6030-Mar.95 Page 1 of 1 I ~"" '... STATE FARM INSURANCE COMPANIES ¡,~,,' State Farm Fire and Casualty Company 4600 25111 Avenue North East Salem,OA 97313-1000 12 POLICY NUMBER I I CONTRACTORS POLICY AUG 28 1997 TO AUG 28 1998 I DATE DUE PLEASE PAY THIS AMOUNT I TO BE PAID BY INSURED 1 a 9 Q8-CQ-0270-1 K-2219-F482 F E CITY OF FEDERAL WAY 33530 1ST WAY S FEDERAL WAY WA 98003-6210 11,1,,1,,1,11,"11"11111,,11",,1,1,"1111111"11,11",1,,1,1 Insured: CARY LANG CONSTRUCTION INC Location: 34618 11TH PL S FEDERAL WAY WA Add Ins-II: CITY OF FEDERAL WAY Mortgagee: HERITAGE BANK Loan No: 0000317735 Forms, Options, and Endorsements ~pecial Form 3 IA Amendatory Endorsement -Debris Removal Endorsement Policy Endorsement Special Form 3 Endorsement Policy Endorsement 1m Attaching Dee Printout Inland Marine Conditions Installation Endorsement Glass Deductible Deletion Employers Liability Loss Payable FP-6100 FE-6247.1 FE-6451 FE-6467 FE-650O FE-6503 FE-8750 FE-8751 FE-8756 FE-6538.1 FE-6413 438 Audit period: Annual Policy number 98-CO-0270-1 replaces 98-CF-5508-9. l- !kif/!!: ~ír,¡ uJ' ~ P. .. Agent JERRY flÁAYBERRY INS AGENCY INC Telephone (206) 839-251 0 00 ctóF RENEWAL CERTIFICATE Coverages and LImits Section I A Buildings B Business Personal Property $430,500 20,100 Deductlbles . Section I Basic Section II Other deductibles may apply - refer to policy 250 250 Section II L Business Liability M Medical Payments Gen Aggregate (Other than PCO) Products-Completed Operations (PCO Aggregate) $1,000,000 5,000 2,000,000 2,000,000 Estimated Prem (See I) Forms, Opts, & Endrsmnt Estimated Prem (See II) Total Amount $1,322.00 958.00 $1,990.00 $4,270.00 Premium Reductions Your premium has already been reduced by the following: Renewal Year Discount Yrs in Business Discount Age of Building Discount Cov. A -Inflation Index: Cov. B - Consumer Price: 130.3 160.2 See reverse side for important information. Please keep this part for your record. Prepared JUL 09 1997 IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. ~ -- K-2219-F482 F NOTE: DO NOT PAY. THE PREMIUM IS BEING PAID BY THE INSURED. DATE DUE PLEASE PAY THIS AMOUNI THIS IS FOR INFORMATION ONLY 98-CO-0270-1 CONTRACTORS 3461811TH PL S FEDERAL WAY WA 1509000005 State Farm Insurance Companies N I FIRE REN I ~ FOR OFFICE USE ONLY 001 M 0000 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement "J your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. 138-3076 F.2 Rev. 01-97 Printed in U.S.A. (01fO08hd IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. IF THIS IS NOT CONVENIENT, PLEASE COMPLETE THE FOllOWING. Residence Phcne No. SlreetorR.R. S1atelPrcvince ZIPlPostal Code Business Phone No. city Township is change: D Permanent County D Temporary D InsideCityUmils D Outside City Umns If temporary, how many months? - Do you plan to return to ycur previous address. DYes D No D Mailing address change on~ D Locationchange {Please see your State Farmagent D Check box rt change applies to A.LL State Farm pol~ies In household (A uto Policyholders Only) Isthevehiciedriventoandfromworl<lsohccl? DYes D No If the answe' is 'yes', what is the av",age weekly rni/eagB fer such use? 138-3076 F.2 Rev. 01-97 I ~ STATE FARM INSURANCE COMPANIES State Farm Fire and Casualty Company 4600 25th Avenue North East Salem,OR 97313-1000 12 POLICY NUMBER I :: Q8-CO-0270-1 I 9 RENEWAL CERTIFICATE SCHEDULE PAGE K-2219-F482 F E CITY OF FEDERAL WAY 33530 1ST WAY S FEDERAL WAY WA 98003-6210 RFcr-.lvra JUL 14 1997 PLEASE PAY THIS AMOUNT 8 7 6 5 4 3 2 " CONTRACTORS POLICY AUG 28 1997 TO AUG 28 1998 I DATE DUE I CONTINUED 11,1111,,1,1111,1111111111111,1111,111,1111,,11,11,11,111111,1 f~A\¡"" . -'.-0 CITY O~ F;~ )Ó'¡I/_\~"}.Y" Forms, Optlonsl and Endorsements Valuable Paper :¡¡20,OOO OPT VP '-- Agent JERRY MAYBERRY INS AGENCY INC Telephone (206) 839-2510 See reverse side for imporlant information. Please keep this part for your record- Prepared JUL 09 1997 IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. K-2219-F482 F DATE DUE PLEASE PAY THIS AMOUNT CONTINUED ~ 98-CO-0270-1 CONTRACTORS 1509000005 State Farm Insurance Companies FIRE REN I B FOR OFFICE USE ONLY N 001 M 0000 71 ~J.. STATE FARM INSURANCE COMPANIES A ¡¡tate Farm Fire and Casually Company '"""0" . 4600 25th Avenue North East Salem,OR 97313-1000 RENEWAL CERTIFICATE Qy 12 ., :: 98-CF-5508-9 9 CONTRACTORS POLICY AUG 28 1996 TO AUG 28 1997 TO BE PAID BY INSURED K-2219F82 F E CITY OF FEDERAL WAY 33530 1ST WAY S FEDERAL WAY WA 98003-6210 Coverages and LImits Section I A Buildings B Business Personal Property Excluded 15,100 11,1"1"1,11",11"",11"11""1,1,,,1111,,,,,11,11,,,1,,1.1 Deductlblas . Section I Basic Section II Other deductibles may apply - refer to polley 250 250 Insured: CARY LANG CONSTRUCTION INC Location: 34815 PACIFIC HIGHWAY S STE A #206 FEDERAL WAY WA Add Ins-II: CITY OF FEDERAL WAY Section II L Business Liability M Medical Payments Gen Aggregate (Other than PCO) Products-Completed Operations (PCO Aggregate) $1,000,000 5,000 2,000,000 2,000,000 Forms, Options, .nd Endorsements Special Form 3 WA Amendatory Endorsement Debris Removal Endorsement Policy Endorsement Employers Liability Special Form 3 Endorsement Poliey Endorsement Valuable Paper $20,000 1m Attaching Dee Printout Inland Marine Conditions Installation Endorsement FP-6100 FE-6247.1 FE-6451 FE-6467 FE-6413 FE-6500 FE-6503 OPT VP FE-8750 FE-8751 FE-8756 Estimated Pram (Sec I) Forms, Opts, & Endrsmnt Estimated Pram (Sac II) Total Amount $116.00 956.00 $2,051.00 $3,123.00 COV. A - Inflation Index: N/A Cov. B - Consumer Price: 156.6 Audit period: Annual Policy number 98-CF-5508-9 replaces 98-BS-2964-1 . ;-, JU.. : .t::D moo "" ." ..' ,:,,8 ",./~¡-FF"":"',LW.w 7'!rMb þ- ~ir¡ (JUel'1/~ F .. Agent JERRY MAYBERRY INS AGENCY INC Telephone (206) 839-2510 See reverse side for important information. Please keep this part for your record. Prepared JUL 15 1996 IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. K-2219F82 F [ 'A. ] .. , CARY LANG CONSTRUCTION INC ,~,. : . 98-CF-5508-9 CONTRACTORS NOTE: DO NOT PAY. THE PREMIUM IS BEING PAID BY THE INSURED. THIS IS FOR INFORMATION ONLY Check here if address change is indicated on back. D 1500000 State Farm Ineurance Companies OFFICE USE ONLY N I FIRE REN ~ 4 M 0000 ,I NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. IF THIS IS NOT CONVENIENT, PLEASE COMPLETE THE FOLLOWING. Note: ~ thl.la a change In In.ured property, please .ee your State Farm Agent. Uat below all other State Farm pollet.. (Auto, Ufe, Fire or Heallh) on which premium notices should be sent to the new addre... (PLEASE PRINl) 0 Mailing addrea. change only 0 Permanent change 0 Location change 0 Temporary change la""ectto be here - months. Pol. No. Insured's N.~ Pol. No. Insured's Name Pol. No. Insured's Name Pol. No. Insured's Name Street or Rural Route Addreaa City St./Prov.- ZIP/Poatal- Townahlp 0 Inside City Umlto County 0 Outolde City Umlto New Realdence Phone No. (-) New Bualneaa Phone No. (- ) Polic.Y~ Number 98-BS-2"54-1 DECLARATIONS PAGE AMENDED 06/ 1 1 /96 A (, q to - JC:ClA" ) STATE FARM FIRE AI'{) CASUALTY COMPANY '0""." 4600 25TH AV N EAST, SALEM OR 97313-1000 ' A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS 2219-F482 K P jUL ~--~ -~- NAMED INSURED AND MAILING ADÒÀ~, -- .-- CARY LANG CONSTRUCTION INC 30117 17TH AVE SW FEDERAL WAY WA 98023-3 -=------------ CONTRACTORS POLICY - SPECIAL FORM 3 {,;;:', ,,- t- c' " COV A - INFLATION COVERAGE INDEX: N/A COV B - CONSUMER PRICE INDEX: 152.2 Automatic Renewal - If the Policy Period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. POLICY PERIOD: 1 YEAR THE POLICY PERIOD BEGINS AND Et{)S AT 12: 01 AM EFFECTIVE DATE: 08/28/95 STANDARD TIME AT THE PREMISES LOCATION. EXPIRAT!!lN DATE: 08/28/96 NAMED INSURED: CORPORATION LOCATION OF COVERED PREMISES: 34815 PACIFIC HIGHWAY S STE A #206 FEDERAL WAY WA 98003-8324 COVERAGES AND PROPERTY SECTION I A BUILDINGS B BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE EXCLUDED $ 14,600 SECTION II L BUSINESS LIABILITY $ 1,000,000 M MEDICAL PAYMENTS $ 5,000 PRODUCTS-COMPLETED OPERATIONS (PCO) AGGREGATE $ 2,000,000 GENERAL AGGREGATE (OTHER THAN PCO) $ 2,000,000 THE SECTION I DEDUCTIBLE WILL BE APPLIED TO EACH OCCURRENCE At{) WILL BE DEDUCTED FROM THE AMOUNT OF LOSS. OTHER DEDUCTIBLES MAY APPLY -- REFER TO YOUR POLICY. FORMS, OPTIONS, AND ENDORSEMENTS SPECIAL FORM 3 WA AMEt{)ATORY ENDORSEMENT DEBRIS REMOVAL ENDORSEMENT POLICY ENDORSEMENT EMPLOYERS LIABILITY SPECIAL FORM 3 ENDORSEMENT POLICY ENDORSEMENT VALUABLE PAPER $20,000 FP-6100 FE-6247,1 FE-6451 FE-6467 FE-6413 FE-6500 FE-6503 OPTION VP CONTINUED ON REVERSE SIDE OF PAGE PREPARED 06/20/96 FP-8051 .1C (08/93) AGET BY YOUR POLICY CONSISTS OF THIS PAGE, ANY ENOORSEMENTS ANO THE POLICY FORM. PLEASE KEEP THESE TOGETHER. YOUR POLICY IS AMEt{)ED 06/11/96: ADDL INSURED NAME & ADDRESS ADDED SECTION II COVERAGE LIMITS CHANGED DEDUCTIBLE-SECTION I $ 250 BASIC DEDUCTIBLE-SECTION II PROPERTY DAMAGE LIAB. $ 250 PER CLAIM ENDORSEME~IT PREMIUM INCREASE $ 84.97 AUDIT PERIOD: AJl.NUAL 19tj~ AGENT ",O"'O, ""7011,2 "".11-94 P'"'ed;" ".S.A, CONTRACTORS POLICY - SPECIAL FORM 3 FORMS, OPTIONS, AND ENDORSEMENTS 1M ATTACHING DEC PRINTOUT FE-8750 INLAND MARINE CONDITIONS FE-8751 INSTALLATION ENDORSEMENT FE-8756 PREPARED 06/20/96 "O119C' e8G Policy No. 98-B8-2964-1 FE.6321 (7/B6) ADDITIONAL INSURED ENDORSEMENT State or Political Subdivisions - Permits ';¡; ,.".."'~ Policy No.: 98-B8-2964-1 Named Insured: CARY LANG CONSTRUCTION INC State or Political Subdivision: CITY OF FEDERAL WAY 33530 1ST WAY S FEDERAL WAY WA 98003-6210 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured any state or political subdivision shown above, subject to the following provisions: 2. This insurance does not apply to: a. bodily injury, property damageo personal injury or advertising injury arising out of operations performed for the state or municipality; or 1. This insurance applies only with respect to operations performed by you or on your behaif for which the state or political subdivision has issued a permit. b. bodily injury or property damage included within the products-completed operations hazard. FE-B321 (7/BB) Printed in U.SA