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• ' CONSTRUCTION CONTRACT THIS AGREEMENT, made and entered into this 18th day of May, 1993, by and between Mangum Concrete Forming hereinafter called the 'Contractor' and the city of Moscow, a Municipal Corporation of Idaho, hereinafter called the 'City'. WITNESSETH THAT: WHEREAS, pursuant to the invitation of the City, extended through an official published 'Advertisement for Bids', the Contractor did, in accordance therewith, on the 21st day of April, 1993, file with the city a proposal containing an offer which was invited by said notice; and WHEREAS, the City has heretofore determined that said offer was the lowest and best submitted: NOW THEREFORE, the Parties hereby agree as follows: I. Complete with Specifications That the Contractor shall comply in every way with the provisions and requirements of those certain specifications entitled: CROSSWALK REPLACEMENT - 1993 II . Contract Documents The following contract documents are hereby made a part of and incorporated into this Agreement by incorporation as though fully set forth herein: 1. The 'Advertisement of Bids' - being the invitation to submit a proposal; 2 . The specifications named above by title; 3 . The detailed plans listed and described in bid specifications, together with those which may be issued as supplements thereof; and, 4. The proposal of the Contractor, submitted on April 21, 1993, th conformed copy of which is her marked 'Exhibit which was original or attached and ---PAGE BREAK--- III. Consideration That in consideration of faithful compliance with the terms and conditions of this agreement (including the specifications) the City shall pay to the Contractor at the times and in the manner provided in said specifications the total sum of eleven thousand, four hundred and nineteen dollars ($11, 419.00) which sum is subject, however, to increase or decrease in such proportion as the quantities named in said proposal are so changed, all as in said specifications and proposal provided. IV. Completion All work shall be completed by August 6, 1993. v. Communications Such communications as are required by this contract shall be satisfied by mailing or by personal delivery to the parties at the following address: Contractor: city: Mangum Concrete Forming 3454 Highway 12 Orofino, ID 83544 City of Moscow 122 E. 4th Street P.O. Box 9203 Moscow, ID 83843 VI. Full Agreement This contract and the incorporated documents shall constitute the full agreement between the parties; any amendments thereto shall be made in writing. IN WITNESS WHEREOF, said contractor and City have caused this agreement to be executed on the day and year first above written. City of Moscow, Idaho: By -O Paul Ggp Mayor ---PAGE BREAK--- ATTEST: STATE OF ;CJ a h l) County of Clev.. vwa fey ) ) ss ) On this /q '!{_day of e. , 19!l..J, before me a Notary Public I personally appeared L e..w m/)1. Yl-!311. M- , known to me to be the owner of Mangum Concrete F.ming, whose name is subscribed to the foregoing instrument and acknowledged to me that he executed the foregoing agreement. STATE OF n County of ss otary PublN in and for tate of _ On this aJJ--{) day of , 19 before me a Notary Public in and for said to, appeared Paul C. Agidim /n0. ElaiHe Russel, known to me to be the Mayor and e±ty F of the City of Moscow and acknowledged to me that they executed the foregoing agreement. t£M/ior State of ---PAGE BREAK--- BIDh l{_RQPOSAL \\E.X IDIT TO: Mayor and city council City of Moscow, Idaho Date: 3 This proposal is submitted as an offer by the undersigned to enter into contract with the City of Moscow, Idaho as represented by the City Council, hereinafter referred to as the 'CITY' for CROSSWALK REPLACEMENT 1993, specified herein and which construction documents are on file with the City Engineer, City Hall, Moscow, Idaho, and which are a condition hereof with the same force and effect as though they were attached hereto. The offer is conditioned on the following declarations as to the facts, intention and understanding of the undersigned and the agreement of the CITY to the terms and prices herein submitted. 1. All project specifications and drawings examined by the undersigned and their terms and conditions are hereby agreed to. 2. The undersigned certifies that he has received or made himself aware of any and all existing site conditions that may affect the proposed work. 3. It is understood that the contract drawings may be supplemented by additional drawings and specifications in explanation and elaboration of the contract drawings and it is agreed that such supplemental drawings, when not in conflict with those referred to in paragraph 1 above, will have the same force and effect as if attached hereto and that when received they will be considered a part of the contract. 4. The undersigned will furnish separate performance and payment bonds in the full amount of the contract price. 5. The cash, cHrtified check, bid bond, or cashier's check accompanying this proposal shall be forfeited to the City of Moscow, Idaho to the extent of 5% of the amount bid if the undersigned shall fail or refuse to execute the contract, furnish performance and payment bonds, and insurance certificate as required by the specifications within the time limit therein after notification that the said proposal is accepted, all in accordance with the provisions of this proposal and the specifications. ---PAGE BREAK--- 6. The undersigned further agrees that the CITY shall have the right to accept or reject any bid item deemed to be in the best interest of the city. 7. The undersigned agrees to order all necessary equipment and materials within a period of three days after Notice to Proceed has been issued by the City Engineer. 8. The undersigned, as a bidder, Number through him and have been examined as documents. acknowledges that Addenda have been delivered to part of the contract 9. The undersigned agrees to complete all work embraced in the contract by the date set forth in paragraph GS- 12(A) of the Specifications. 10. The undersigned holds Idaho State Contractor's License Number fi?OtJ 2. -6 11. The undersigned proposes to use the following sub contractors in the performance of meeting the contract requirements: Subcontractors Trade Specialty Amount a. _ _ b. c. _ 12. The undersigned proposes to furnish labor, materials, equipment and services of all kinds required for CROSSWALK REPLACEMENT - 1993, as described in the specifications, including all appurtenant work, all as required by the specifications and this proposal for the prices in accordance with the completed schedule of contract prices as follows: BID SCHEDULE 1. Remove and replace 890 square feet crosswalk on the west side of Sixth and of concrete Washington, c.9Jllº»te, at !¼ '.liE kNlf7 D d- 0 '/1?0 (unit price in words) per square foot for a total price of $ I{ lJ??rSO ---PAGE BREAK--- ALTERNATE BID SCHEDULE A-1 Remove and replace the tlIJ\KL. 865 square feet of concrete e\t l Third and Jackson, complete, unit rice in words per square foot for a total price of A-2 Remove and replace 450 square feet of concrete DtEF\GH crosswalk on the west side of First and Main, south half, P complete, at /?)t2f d/14/I..S d- (unit price in words) per square foot for a total price of $ S/fJghij Firm Signature of Bidder Official Title JysY Cy Mailing AdREƙS ! P"d·Of VL:f if LYIMU&L $ Q(Q() I 0 ! ,!lflr ,:J•I l',ll • • J_ ! 1. : . . : . i I DOLLARS i thnn l.llg y f - ---PAGE BREAK--- WEST ONE BANK. IDAHO, N.A. P.O. BOX 1240 17807 OROFINO. ID ..!3544 J./aOltlb 73 92-1,1241 DATE - 19 - DOLLARS ---PAGE BREAK--- Bond No. P 2405613 PLANET INSURANCE CO:MPANY HEAD OFFICE, SUN PRAIRIE, WISCONSIN Administrative Office, Federal Way. WA PERFORMANCE BOND The American Institute of Architects, AlA Document A311, February 1970 Edition. KNOW ALL MEN BY THESE PRESENTS: that (Here insert lull name and address or legal title of Contractor) LEW MANGUM DBA MANGUM CONCRETE FORMING 3454 Highway 12, Orofino, ID 83544 as Principal, hereinafter called Contractor, and, PLANET INSURANCE COMPANY, a corporation of the State of Wisconsin, with its Head Office at Sun Prairie, Wisconsin, as Surety, hereinafter called Surety, are held and firmly bound unto {Here insert full name and address or legal title of Owner) CITY OF MOSCOW P.O. Box 9203 Moscow, ID 83843 as Obligee, hereinafter called Owner, in the amount of ELEVEN THOUSAND FOUR HUNDRED NINETEEN AND Dollars 11 , 419 • 00 for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrator, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Contractor has by written agreement dated May 18 19 93 , entered into a contract with Owner for CROSSWALK REPLACEMENT - 1993 in accordance with Drawings and Specifications prepared by (Here insert full name and address or legal title of Arch11ect) which contract is by reference made a part hereof, and is hereinafter referred to as the Contract NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall and faithfully perform said Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect The Surety hereby waives notice of any alterations or extension of time made by the Owner. Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Owner having performed Owner's obligations thereunder, the Surety may remedy the default, or shall 1) Complete the Contract in accordance with its terms and conditions, or 2) Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon determination by Surety of the lowest responsible bidder, or, if the Owner elects, upon determination by the Owner and the Surety jointly of the lowest responsible bidder, arrange for a contract between such bidder and Owner, and make available as Work progresses (even though there should be a default or a succession of defaults under the contract or contracts of completion arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the contract price; but not exceeding, including other costs and damages for which the Surety may be liable hereunder, the amount set forth in the first paragraph hereof. The term "balance of the contract price," as used in this paragraph, shall mean the total amount payable by Owner to Contractor under the Contract and any amendments thereto, less the amount properly paid by Owner to Contractor. Any suit under this bond must be instituted before the expiration of two years from the date on which final payment under the contract falls due. No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein or the heirs, executors, administrators or successors of Owner. Signed and sealed this 4fYiA h ..UJtid7!unth Cheryl P ·mmer Performance nd Rev1sed to February, 1970 SB 5715ax Printed 1n USA BDP-2304 (9/86) (Witness) 15th day of June 1933 Mangum Concrete Forming (Seal) 'A Pdti pal) (Title) _ @NCE COMPANY Lee P. h isen (TmƘ Attorner-1n-Fact ---PAGE BREAK--- PLANETINSURANCECOnPANY HEAD CIFFICE. SUN PRAIRIE, WISCONSIN POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS. That the PLANET INSURANCE COMPANY. a corporation duly organized under the laws of the State of Wisconstn. does hereby make, constitute and appotnt LEE P. THEISEN of SPOKANE, WASHINGTON its true and lawful Attorney-in-Fact to make, execute. seal and deliver for and on its behalf. and as its act and deed ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP and to bind the PLANET INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of the PLANET INSURANCE COMPANY and sealed and attested by one other of such officers, and hereby ratifies and confirms all that its said Attomey(s)-in-Fact may do in pursuance hereof. This Power of Attorney is granted under and by authority of Article VII of the By-Laws of PLANET INSURANCE COMPANY which became effective September 21, 1981, which provisions are now in full force and eflect, reading as follows: ARTICLE VII -EXECUTION OF BONDS AND UNDERTAKINGS 1. The Board of Directors, the President, the Chairman of the Board, any Senior Vice President. any Vice President or Assistant Vice President or other officer designated by the Board of Directors shall have power and authority to appoint Attorneys-in-Fact and to authorize them to execute on behalf of the Company, bonds and undertakings. recognizances. contracts of indemnity and other writings obligatory in the nature thereof, and to remove any such Attorney-in-Fact at any time and revoke the power and authority given to him. 2. Attorneys-in-Fact shaU have power and authority, subject to the terms and limitations of the power of attorney issued to them, to execute and deliver on behalf of the Company, bonds and undertakings. recognizances, contracts of indemnity and other writings obligatory in the nature thereof. The coiJ,orate seal is not necessary for the validity of any bonds and undertakings, recognizances. contracts of indemnity and other writings obligatory in the nature thereof. 3. Attorneys-in-Fact shall have power and authority to execute affidavits required to be attached to bonds, recognizances. contracts of indemnity or other conditional or obligatory undertakings and they shall also have power and authority to certify the financial statement of the Company and to copC of the By-Laws of the Company or any article or section thereof. This power of attorney is signed and sealed by facsimile under and by authority of the following Resolution adopted by the Board of Directors of PLANET INSURANCE COMPANY at a meeting held on the 29th day of March, 1982, at which a quorum was present, and said Resolution has not been amended or repealed: "Resolved, that the signatures of such directors and officers and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the Mure with respect to any bond or undertaking to which it is attached." IN WITNESS WHEREOF, the PLANET INSURANCE COMPANY has caused these presentsĺ be signed by its Vice President, and its corporate seal to be hereto affixed, this 8th day of July 19 91 STATE OF COUNTY OF On this Washington King 8th day of PLANET INSURANCE COMPANY da Vice President July ,19 91 . personally appeared Lawrence W. to me known to be the Vice-President of the PLANET INSURANCE COMPANY. and acknowledged that he executed and attĻ the foregoing instrument and affixed the seal of said corporation thereto. and that Articl ·on 1, 2, and 3 of the By-Laws of said Company, and the Resolution, aet fot1h therein, are still in full force. My Commission Expires: May 15 ,19 9 4 Residing at Tacoma I, Keith A. Poling , Assistant Secretary of the PLANET INSURANCE COMPANY, do hereby certify that the aboVe and foregoing is a true arid correct copy of a Power of Attorney executed by said PLANET INSURANCE COMPANY, which is still in full force and effect IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Company this BOP-14311/82 ---PAGE BREAK--- Bond No. P 2405613 PLANET INSURANCE CO:M:PANY HEAD OFFICE, SUN PRAIRIE, WISCONSIN LABOR AND MATERIAL PAYMENT BOND The American Institute of Architects, AlA Document A311, February 1970 Edition. THIS BOND IS ISSUED SIMULTANEOUSLY WITH PERFORMANCE BOND IN FAVOR OF THE OWNER CONDITIONED ON THE FULL AND FAITHFUL PERFORMANCE OF THE CONTRACT KNOW ALL MEN BY THESE PRESENTS: that (Here insert full name and address or legal title of Contractor) LEW MANGUM DBA MANGUM CONCRETE FORMING 3454 Highway 12, orofino, ID 83544 as Principal, hereinafter called Principal, and, PLANET INSURANCE COMPANY, a corporation of the State of Wisconsin with its Head Office at Sun Prairie, Wisconsin, as Surety, hereinafter called Surety, are held and firmly bound unto (Here insert full name and address or legal title of Owner) CITY OF MOSCOW P.O. Box 9203 Moscow, ID 83843 as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinbelow defined, in the amount of ELEVEN THOUSAND FOUR HUNDRED NINETEEN AND N0/100--------Dollars($11,419.00 for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Principal has by written agreement dated Owner for May 18 CROSSWALK REPLACEMENT - 1993 19 93 . entered into a contract with in accordance with Drawings and Specifications prepared by (Here insert full name and address or legal title of Architect) which contract is by reference made a part hereof, and is hereinafter referred to as the Contract. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Principal shall make payment to all claimants as hereinafter defined, for all labor and material used or reasonably required for use in the performance of the Contract, then this obligation shall be void; otherwise it shall remain in full force and effect, subject, however, to the following conditions: 1. A claimant is defined as one having a direct contract with the Principal or with a Subcontractor of the Principal for labor. material, or both, used or reasonably required for use in the performance of the Contract, labor and material being construed to in clude that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental of equipment directly applicable to the Contract. 2. The above named Principal and Surety hereby jointly and severally agree with the Owner that every claimant as herein defined, who has not been paid in full before the expiration of a period of ninety (90) days after the date on which the last of such claimant's work or labor was done or performed, or materials were furnished by such claimant, may sue on this bond for the use of such claimant, prosecute the suit to final judgment for such sum or sums as may be justly due claimant, and have execution thereon. The Owner shall not be liable for the payment of any costs or expenses of any such suit. ---PAGE BREAK--- PLANETINSURANCECOoPANY HEAD C:FfiCE, SUN PRAIRIE, WISCONSIN POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS. That the PLANET INSURANCE COMPANY. a corporation duly organiZed under the laws of the State of Wisconsin. does hereby make, and appoint LEE P. THEISEN of SPOKANE, WASHINGTON 1ts true and lawful Attorney-in-Fact to make, execute, seal and deliver for and on its behalf. and as its act and deed ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP and to bind the PLANET INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of the PLANET INSURANCE COMPANY and sealed and attested by one other of such officers. and hereby ratifies and confirms all that its said Attomey(s)-in-Fact may do in pursuance hereof. This Power of Attorney is granted under and by authority of Article VII of the By-Laws of PLANET INSURANCE COMPANY which became effective September 21, 1981, which provisions are now in full force and effect. reading as follows: ANTICLE VII - EXECUTION OF BONDS AND UNDERTAKINGS 1. The Board ol Directors, the President, the Chairman of the Board, any SeniOf Vice President. any Vice President or Assistant Vice President or other officer designated by the Board of Directors shall have power and authority to appoint AttOfneys-in-Fact and to authorize them to execute on behalf ol the Company, bonds and undertakings. recognizances. contracts of indemnity and other writings obligatory in the nature thereof, and to remove any such Attorney-in-Fact at any time and revoke the power and authority given to him. 2. AttOfneys-in-Fact shall have power and authority, subject to the terms and limitations of the power of attorney issued to them, to execute and deliver on behalf of the Company, bonds and undertakings. recognizances, contracts of indemnity and other writings obligatory in the nature thereof. The corP<>rate seal is not necessary for the validity of any bonds and undertakings, recognizances. contracts of indemnity and other writings obligatory in the nature thereof. 3. Attorneys-in-Fact shall have power and authority to execute affidavits required to be attached to bonds, recognizances, contracts of indemnity Of other conditional Of obligatory undertakings and they shall also have power and authority to certify the financial statement of the Company and to copC of the By-Laws of the Company or any article or section thereof. This power of attorney is signed and sealed by facsimile under and by authority of the following Resolution adopted by the Board of Directors of PLANET INSURANCE COMPANY at a meeting held on the 29th day of March, 1982, at which a quorum was present. and said Resolution has not been amended or repealed: MResolved, thai the signatures of such directors and officers and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto by facsimile, and any such power of attorney Of certificate bearing such facsimile signatures Of facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by facsimile signatures and facsimile seat shall be valid and binding upon the Company in the future with respect to any bond Of undertaking to which it is attached." IN WITNESS WHEREOF, the PlANET INSURANCE COMPANY has caused these presents to be signed by its Vice President. and its corporate seal to beheretoaffixed,this 8th dayof July 19 91 STATE OF COUNTY OF On lhia Washington King 8th day of PLANET INSURANCE COMPANY df&t?Z> VIce President July • 19 91 . personally appeared Lawrence W. to me known to be the Vice-President of the PLANET INSURANCE COMPANY, and acknowledged that he executed and attested the foregoing instrument and affixed the seal of said corporation thereto, and that Articl ·on 1, 2, and 3 of the By-Laws of said Company, and the Resolution, eet forth therein, are still in full torce. My Commission Expires: May 15 ,19 9 4 Residing at Tacoma I, Keith A. Poling , Assistant Secretary of the PLANET INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by said PLANET INSURANCE COMPANY, which is still in full force and effect. IN WITNESS WHEREOF,! have hereunto set my hand and affixed the seal of said Company this BDP-1431 1/82 ---PAGE BREAK--- lA C q R D C E R T IF ) A TE 0 F l *I+N-=S-=U,R SS=U= E0D1A2 T 3 E=-40566/71849/: 9;3< I PRODUCER I ļRATB INSURANCE AGCY INC I 163 JOHNSON AVENUE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I PO BOX 788 C O M P A N I E S A FFO R D I N G I OROFINO ID 83544 COMPANY I LETTER A I COMPANY AMERICAN STATES INSURANCE C O V E R A G E 1 INSURED COMPANY I Lewton Mangum DBA: LETTER C I Mangums Concrete Forming COMPANY I 3454 Bwy 12 LETTER D I orofino, Idaho 83544 COMPANY I C 0 V E R A G E S THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lco 1 POLICY EFF. POLICY EXP.I ILTRI TYPE oF INSURANCE POLICY NUMBER DATE DATE I L _ T_ s _ I GENERAL LIABILITY I GENERAL AGGREGATE I Commercial General Liability! I PRODUCTS-COMP/OP AGGREGATE I A ( ] Claims Made Occur. 01-CC-113247 10/30/92 10/30/93 I PERSONAL & ADV. INJURY I owner's & Contractor's Prot. I I EACH OCCURRENCE I I FIRE DAMAGE (Any one fire) I I MED. EXPENSE (Any one person) I AUTOMOBILE LIABILITY I COMBINED SINGLE I Any Auto I_L=I=M.:.::Ic=T I ( ) All awned Autos I BODILY INJURY I Scheduled Autos 1 I A ) Hired Autos 01-CC-113247 10/30/92 10/30/93 I BODILY INJURY I ( ) Non-OWned Autos 1 ) 1 ( ] Garage Liability I PROPERTY DAMAGE I [ 1 EXCESS LIABILITY I EACH OCCURRENCE I [ l UMBRELLA FORM I_A;;;.G.;..;GRE=GA=TE _ I ! _ _ I I [ 1 STATUTORY LIMITS I WORKER • s COMPENSATION I_EA _ c _ H _ A_ cc _I _ D_ E_ 1 AND I DISEASE-POLICY LIMIT I _ _ Y TYc:;_ _ _ _ I DISEASE-EACH EMPLOYEE I ĽER I I I $ 1,000,000 $ 1,000,000 $ 500,000 $ 500,000 $ 50,000 $ 5,000 $ 300,000 $ $ $ $ $ $ $ $ I 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS I I I 1 C E R T I F I C A T E I I I City of Moscow I . V P.O. Box 9203 I \If Moscow, ID I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR I 83 843 I LI AB ľ Ic:: F_ANc::;_; u-'-p - E RE:::P:..:RE =s - 1 I AUTHORIZED REPRESENTATIVE a l ! f.r" !ACORD 25- S (7/90) L.f ` _ CORPORATION 1990 ---PAGE BREAK--- ISSUED Ta: CITY Or 1"iOSCOW ATTN: DEA7-I kEYEN P.O. BCX ID 83343 STATE INSUkNC2 FUND 1215 tJ. ST!1TC: S T A T H C U S E i•l 1\ : L 3CISE, IDAHO j372C CERliFICsTE OF INSURFNCE PROJECT: , . IJ . - l • ' 'I 11 - 1 ' ' · t f • : Ɩ Ɨ t \o 1 • ' 1 !i I. . l } - . t . n ; J u N 1 -t:Ji'm L . 1 I / ʾt: , ,ˁ { t. . . . Ul! . . , . LJT:S\::jno ·Jr?:rLV THe STATE iNSUftNCE FUND HERE8Y CEtTIFIES THT TH€ INSURANCE PLICY HEREUNDER DESChIiED IS IN FULL FORCE ANC EF ƕE CT 0N THE DATE OF TH I S CERliFICAT AND THAT IT REMAINS Iu FULL FORCE AˠD EFFEC: UNTIL CANCELLED. NˎˏE(S) Of ISURD: MAˌGUM L6v D DdA: MANGUw5 CONCRETE FJR,ING MAILING DDRESS OF INSURʿC:3454 HWY 12 ORCFINO, (0 f.354L. )OllCY Iˋ FORCE FRO ˔OVEM˕E˖ 20, 19E˟ 12:C1 STANDAkD TI=E 4T TH> A DDR ESS OF THE INSUR*D ShOWN ˉSOVˊ CR TH˄ J0˅ SITF IN IDAHO. TY?E JF IxSUyANCz CKERS COjPEN3ATION CCCUPATIONPL C!SEASE EMPLOYER'S Lift8ILITY LIMITS: P.:LICY NlJ"'l8ER 5216ˍ6 CJ\tE.RAGc 3UJCT TO THE Tc?MS OF TH{ ːCRKERS LAWS A˒D OCCUPftTIONAL DISEASE LAWS Of THe STATr OF IDAHO 60DILY IˡJUˢY 3Y ACCIOEhT - S1QO,CCQ EA CH 4CCIDEN1 EJDILY INJURY 3Y DISEAS - ˘500,0CC PvLICY LIMIT dODILY INJURY BY DISEAS˓ - 100,000 EAC EMPLOYE TnE INSUKA˝C˞ COVRAE APPLIˑS TO E˙PLJY˚˛S OF THT AdCVE-"cNTIONED COMPAlY w0RKIN3 ANYˀHERE IN TH+ ,TATE Of IDAHO AND ALSu TO ANY EUPLCYEVS LIV#NG IN IDAHO 2UT ORKING TEMP02AR!LY IN A NEIGH30RING STATI. IN ADDITION TO THE REWUIREO COVE}AG~, THE FCLLOwiNG ELECTED COVERAGE ALSO A?PLIES: THIS CETifiCT IS VALID FCR ON˃ YEAQ fqCM DTE CF CERTIFICATE. IN TE EVENT Jf JF SAID ?OLICY, TH STATE INSLRANCE FUND WILL ND EAV0R TG NOTIFY THE PARTY TO ˇHOˈ ThiS CERTIFICATE !S ISSLED gy PROVIDING TEN (101 DAYS ADVANCE NOTICW, UT THE STAT€ ISURANCE FUˆD ShALL NOT ˂E LIAbLE IN A˜Y WAY FOR F ILURt TC GIV: SLCH NOTICE. S IF 00204 U3KARL P2036C201 6/09/'13