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HomeMy WebLinkAbout20260413_PWD3507_Preconstruction Documents City of Arlington Community & Economic Development 18204 59th Avenue NE, #B - Arlington, WA, 98223 - 360-403-3551 – www.arlingtonwa.gov July 11, 2023 Arlington School District #16 315 N French Ave Arlington, WA 98223 RE: Pre-Construction Requirements Project Name: Eagle Creek Elementary Portables Project Address: 1216 E 5th St. , Arlington, WA 98223 Project No.: PWD-3507 Dear Mr. Kent, In order for work to commence at the Eagle Creek Elementary Portables project site, the following items need to be submitted to the City of Arlington: 1. Contractor Information: a. License No. and 24 hour emergency contact information b. Contractor must obtain a City of Arlington Business License c. Contractor Proof of Insurance with the City of Arlington named as Additional Insured 2. Project CESCL with current certificate 3. Project Testing Company with contact information 4. Department of Ecology Construction Stormwater General Permit (1 acre or more). 5. Material submittals for all proposed water, sewer and stormwater infrastructure shall be approved. Allow one (1) weeks’ time for review of material submittals. Once the items above have been received and approved, a pre-construction meeting will be scheduled. Project closeout information The project shall be deemed complete when inspection and approval of all work has been completed, and as-built plans have been approved. Should you have any questions or require additional information, please contact me at 360.403.3551 or rjones@arlingtonwa.gov. Sincerely, Raelynn Jones Permit Technician II Community & Economic Development Department PRE-CONSTRUCTION MEETING AGENDA Community and Economic Development City of Arlington • 18204 59th Avenue NE • Arlington, WA 98223 • Phone (360) 403 3551 Project Name: Eagle Creek Elementary Portables Project No.: PWD-3507 Date 8/1/2023 Contractor: Pacific Mobile Structures Superintendent: Robbie Taylor Ph. No.: 360-572-5018 The purpose of this meeting is to provide the most common inspections and noteworthy information. This meeting is not intended to be all-encompassing. It is the responsibility of the Owner, Developer and Contractor to adhere to the approved plans, verify compliance with the City of Arlington Municipal Code, Public Works Design and Construction Standards, International Code Council (ICC), applicable local, state and federal requirements or any order, proclamation, guidance or decision of the Governor. In addition, construction sites shall adhere to current COVID-19 Jobsite Safety Requirements as per local, state and federal regulations. INSPECTIONS • INSPECTIONS (360-403-3417) MUST BE CALLED IN BEFORE 3:30 PM TO BE ON THE NEXT BUSINESS DAY INSPECTION SCHEDULE • Inspections are Monday-Friday with exception of Local, State or Federal Holidays. Building, Storm and Civil Inspections - 8 am to 4:30 pm; Water or Sewer inspections - 8:00 am to 3:30 pm • To cancel or modify an inspection - Building, Storm or Civil call 360-403-3433; Water or Sewer call 360-403-3526 • It is the responsibility of the Owner, Developer and Contractor to call and arrange for appropriate inspections. Onsite tailgate meetings are advised with each individual inspector prior to installation of their related facilities with those persons who are actually performing the work. • Failure to call for inspection may result in work being left exposed and/or removed and reconstructed • Re-inspections may be charged at $127.00 per hour, ½ hour minimum for failure to call for inspection. Submittal Documents    Robbie Taylor 360-572-5018  Copies of other agency permits or proof that the application is in progress:  9566289 Exp 6/1/2024 One week prior to the pre-construction meeting. Submittals for all materials and subcontractor approvals: DISCUSS AT PRE-CON AS NECESSARY Performance Bond must be on file: N/A  City of Arlington Business License: Current Nelson Geotech / Terracon  CESCL#: Exp.: ~Need separate legal and exhibit map for City Council Approval – REQUIRED WITH AS-BUILT SUBMITTAL Contact State Historical Preservation Officer and Stillaguamish Tribe if required per Land Use PermitStillaguamish Tribe of Indians - THPO@stillaguamish.com Sam Barr Ph.: 360-622-7055; sbarr@stillaguamish.com City of Arlington Design and Construction Standards and Specifications. (Available online)  UPCOMING HOLIDAYS – SEE FULL LIST OF 2023 FEDERAL HOLIDAYS Binders and approved plans shall be kept onsite As-built plans will be required – submit contractor redlined plans with as-built submittal Page 2 of 5 REV6.2021 MISCELLANEOUS: 1. Bulk Hydrant Use – 360-403-3526 2. Call for Locates 3. Planting schedule and methods 4. Onsite inspection prior to and during planting 5. Inspect final grade for lawn installation (Hydro-seed/sod) 6. Verify root barrier installation 7. Planting methods & before planting mulch installation 8. Staking & top mulch installation GENERAL CIVIL AND STORM DRAINAGE REQUIREMENTS: 9. Keep road clean and overall site. 10. Dust control required. 11. Maintain construction entrance – use railroad ballast – no spawls. 12. Silt fence as needed – contact for tailgate discussion. 13. All grouting shall be inspected inside and out. 14. Sand collars required unless otherwise specified. 15. All risers to be wet set and mudded inside and out. 16. All infiltration areas to be inspected before cover. 17. Provide protection for all infiltrating materials / amended soils, railroad ballast, drain rock 18. ECO Pans required for concrete clean up or approved wash down area with water tight containment. 19. CDF is required in right of way per R-140, up to the bottom of asphalt; no compaction required. Only for trenching within the roadway prism. 20. A Traffic Control Plan shall be submitted and approved prior to any work within the public Right of Way. 21. Landscaping – root barriers are required per Standard Detail R-270. 22. CALL INSPECTION LINES AND NOT INDIVIDUAL CELL PHONES!! 23. Right of Way site plan and TCP is required for any right of way work. WSDOT TCP is acceptable or TCP per MUTCD. GENERAL UTILITY REQUIREMENTS: 24. Do not cover without inspection. 25. Maintain survey staking. 26. All pipe in ground shall be inspected before cover. 27. Take pictures. 28. Call if you have any questions. 29. No pipe received on site without the ends covered; covers will remain in place until installation. 30. Signed set of approved construction drawings will be on site. 31. General site maintenance - No garbage in the ditch; no fittings/pipe in the mud; fitting assembly in a clean area. 32. Maintain horizontal and vertical clearance with other utilities. 33. Maximum amount of open trench shall not exceed 100 feet. 34. Dropped and/or damaged pipe will be removed from the site and replaced. 35. High ground water a potential and dewatering plan may be required. De-watering pumps will need to be available and in good working condition if needed. 36. A Red Line copy of the construction drawings will be submitted to the COA at the project completion with the as-built plans. Page 3 of 5 REV6.2021 37. Tracer Tape is required over side sewer pipes, stubs and any undetectable pipe at 24 to 48 inches below finished grade extending the full length. GENERAL WATER REQUIREMENTS: 38. Irrigation requires a separate tap for irrigation or a variance can be requested; send to Ryan Morrison rmorrison@arlingtonwa.gov. 39. CDF not required but compaction shall be met. 40. Inspectors shall be contacted and pictures will be taken. 41. All service lines shall be 2 inches and reduced at meter. 42. No 2 inches setters will be installed without restraint rods/spacer (Spud) in place. No wood spacers. 43. Pipe handling - Anticipate low water flows for flushing, keep the pipe/fittings clean. Water tight plug shall be used. 44. Once fittings arrive on site they need to be verified that they conform to approved submittals/COA STD. 45. Reduced Pressure Backflow Assembly (RPBA) is required, preferably inside the building. The RPBA must be in line where the water enters the building. Placement of the RPBA is a minimum of 1 foot and a maximum of 5 feet from ground level. 46. Mega Lugs and Field Locks are required. 47. All valves to be in the closed position to prevent debris/water from entering pipe. 48. Heavy plastic (4 mil. min.) on all fittings prior the thrust blocking. 49. Pre-block and post-block inspections are required. An ecology block may be used with crushed rock backfill compacted to 95%, as needed. • Ecology ½ block - 2’x2’x3’ (1900 lbs.); or • Ecology full block – 2’x2’x6’ (3850 lbs.); or • Per standard detail W-160 thru W-175. 50. All Services will be flushed prior to testing or connecting to the check valve to prevent the check valve from damage. 51. What type of chlorination will you use? Disposal of the Super Chlorinated water? 52. Tie-in connections shall be less than 18 feet and swabbed with a chlorinated water solution of appropriate strength. 53. Water meter will not be set until connection fees have been paid. Contact the Permit Center for or apply online. 360-403-3551 or www.arlingtonwa.gov/254/Construction-Utility-Applications 54. Limited hydrant meters, PUD may supply. GENERAL SANITARY SEWER REQUIREMENTS 55. Inspectors will take pictures. 56. Side sewer pipe and stubs shall be 6 inches. 57. Bedding shall be 3/8 inch clean washed pea gravel or imported clean sand, 6 inches below pipe and 12 inches above pipe. 58. Cleanouts shall be placed 5 feet from the building where each sewer stub exits the building. Cleanouts are required every 100 feet, must be at grade with ring, cover and internal plug, not a cap. If a clean out is not located in a solid surface, it will require a concrete pad. 59. All grouting shall be inspected inside and out. 60. All risers to be wet set and mudded inside and out. Do not use Jet set. 61. Sanitary Sewer Pipe shall be cleaned and tested after backfilling by either exfiltration or low pressure air method. 62. Sewer main will be CCTV and inspector shall be onsite. 63. Clean outs will be a “Y” at 45°. Page 4 of 5 REV6.2021 64. Monitoring manhole (MMH) is required for each commercial use within the city. If multi-tenant, each unit needs to connect separately to a MMH. Maximum of three (3) units may connect to one (1) MMH. Detail SS-130. BUILDING REQUIREMENTS 65. Special Inspections 66. Wall/rockeries separate building permit 67. Field Revisions to Issued Permit – Level 1: Minor changes that Inspectors may add to the approved building permit file. The inspector may also determine that a level 2 requirement is necessary based on the extent and complexity of the changes proposed. “Minor Changes” would include small scale changes, such as: • Updates to floor plan with no increases in footprint, change of uses, or heights. • Minor structural changes from the engineer and/or designer of record; such as: o basic beam changes, o changes of covered porches, patios, o over framed areas from trusses to stick framed roofs w/50 psf. or less roof snow loads without roof pitch changes, o window changes without egress change, o minor footing/foundation adjustments). • All changes/modifications should be noted/documented on the permit file and as necessary within the permitting system. 68. Revisions to Issued Permit – Level 2 New applications may be required for minor revisions where staff review is necessary for proposed revisions. Only 1 revision is allowed to any issued building permit. • Types of potential changes may include but are not limited to: o Reallocation of floor area use if it would include and/or cause an increase in bedroom count(s). o Site plan changes in orientation or location on a site without any structural changes. o Roof pitch changes. o Structural changes and alterations that would then require some type of building plan review. o Slight increases and/or adjustments to previously permitted details and/or features which would increase the area and/or footprint square footage, including, but not limited to:  decks,  covered porches/decks,  existing room(s)/habitable space,  garage • Increases shall not exceed 10% of the existing detail/floor area up to a maximum total of 250 sq. ft. • Increases and/or adjustments shall not create a nonconforming structure (e.g. setbacks, floodplain, critical area, shoreline, ADU limitations, or would create other type of nonconforming use). 69. Revisions to Issued Permit – Level 3 Requirements for new Permit application and full review of Substantial Changes: Changes in the scope and scale of the structure and/or structural design that would necessitate a new permit. Page 5 of 5 REV6.2021 • “Substantial Changes” would include changes, such as: o Changing from wood to reinforced concrete or other change in the type of construction. o Changes in occupancy that require extensive changes to the construction and life safety design of the structure. o Altered projects resulting in a totally new configuration/layout. o A completely new design, new elements, and/or features not part of the original prior approved building permit. GENERAL REQUIREMENTS: 70. Permit numbers shall be added to all required reports and emailed to the following: • Kevin Olander – kolander@arlingtonwa.gov 360-403-3433 • Brian Grieve- bgrieve@arlingtonwa.gov 360-403-3438 / 360-913-1396 (cell) • Permit Center – ced@arlingtonwa.gov 360-403-3551 71. Utility General Contact Information: 360-403-3526 • Water Department Contact: o Gus Tararan – gtararan@arlingotnwa.gov 425-754-7438 o Inspections – 360-403-3526 • Wastewater Department Contact: o Joe Wilson – jwilson@arlingotnwa.gov 425-754-7442 o Inspections – 360-403-3508 72. Plan Revisions shall be submitted via hard copy to CED Department for review. • Two (2) copies of revised plans shall be required along with an electronic copy 73. Meeting Attendees: Profit Corporation PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 Unified Business ID #: 600498022 Business ID #: 001 Location: 0001 Expires: May 31, 2024 Issue Date: Jun 23, 2023 CITY/COUNTY ENDORSEMENTS: KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE EAST WENATCHEE GENERAL BUSINESS - NON-RESIDENT - ACTIVE ELLENSBURG GENERAL BUSINESS - NON-RESIDENT - ACTIVE WALLA WALLA GENERAL BUSINESS - NON-RESIDENT - ACTIVE PUYALLUP GENERAL BUSINESS - NON-RESIDENT #2008043 - ACTIVE LAKEWOOD GENERAL BUSINESS - NON-RESIDENT #BL02-01760 - ACTIVE BAINBRIDGE ISLAND GENERAL BUSINESS #42551 - ACTIVE CENTRALIA GENERAL BUSINESS - NON-RESIDENT #1574 - ACTIVE YELM GENERAL BUSINESS - NON-RESIDENT #10526 - ACTIVE SHELTON GENERAL BUSINESS #0009420 - ACTIVE KIRKLAND GENERAL BUSINESS - NON-RESIDENT #OBL-0004624 - ACTIVE RIDGEFIELD GENERAL BUSINESS - NON-RESIDENT #00499 - ACTIVE UNEMPLOYMENT INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE INDUSTRIAL INSURANCE - ACTIVE TAX REGISTRATION - ACTIVE UBI: 600498022 001 0001 PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE TAX REGISTRATION - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE Expires: May 31, 2024 Profit Corporation PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 Unified Business ID #: 600498022 Business ID #: 001 Location: 0001 Expires: May 31, 2024 Issue Date: Jun 23, 2023 CITY/COUNTY ENDORSEMENTS: BELLINGHAM GENERAL BUSINESS #016514 - ACTIVE CONNELL GENERAL BUSINESS - NON-RESIDENT - ACTIVE COVINGTON GENERAL BUSINESS - NON-RESIDENT #BL01-069 - ACTIVE DEER PARK GENERAL BUSINESS - NON-RESIDENT - ACTIVE EATONVILLE GENERAL BUSINESS - NON-RESIDENT - ACTIVE GRANITE FALLS GENERAL BUSINESS - NON-RESIDENT (EXPIRES 6/30/2024) - ACTIVE ISSAQUAH GENERAL BUSINESS - NON-RESIDENT - ACTIVE KENNEWICK GENERAL BUSINESS - NON-RESIDENT - ACTIVE LACEY GENERAL BUSINESS - NON-RESIDENT #1365 - ACTIVE LAKE STEVENS GENERAL BUSINESS - NON-RESIDENT - ACTIVE LONGVIEW GENERAL BUSINESS - NON-RESIDENT #595453 - ACTIVE MARYSVILLE GENERAL BUSINESS - NON-RESIDENT #0121RET600 - ACTIVE MONROE GENERAL BUSINESS - NON-RESIDENT - ACTIVE NORTH BEND GENERAL BUSINESS - NON-RESIDENT #006089.0 - ACTIVE OLYMPIA GENERAL BUSINESS - NON-RESIDENT #1906 - ACTIVE PORT ORCHARD GENERAL BUSINESS - NON-RESIDENT #B000453 - ACTIVE PORT TOWNSEND GENERAL BUSINESS - NON-RESIDENT #6068 - ACTIVE POULSBO GENERAL BUSINESS - NON-RESIDENT - ACTIVE PROSSER GENERAL BUSINESS - NON-RESIDENT - ACTIVE UBI: 600498022 001 0001 PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE TAX REGISTRATION - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE Expires: May 31, 2024 Profit Corporation PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 Unified Business ID #: 600498022 Business ID #: 001 Location: 0001 Expires: May 31, 2024 Issue Date: Jun 23, 2023 CITY/COUNTY ENDORSEMENTS: RICHLAND GENERAL BUSINESS - NON-RESIDENT #F0C514 - ACTIVE RUSTON GENERAL BUSINESS - NON-RESIDENT #08-186 - ACTIVE SAMMAMISH GENERAL BUSINESS - NON-RESIDENT - ACTIVE SEDRO WOOLLEY GENERAL BUSINESS - NON-RESIDENT - ACTIVE SPOKANE VALLEY GENERAL BUSINESS - NON-RESIDENT - ACTIVE SUMNER GENERAL BUSINESS - NON-RESIDENT - ACTIVE TUMWATER GENERAL BUSINESS - NON-RESIDENT #R-003089 - ACTIVE WASHOUGAL GENERAL BUSINESS - NON-RESIDENT - ACTIVE VANCOUVER GENERAL BUSINESS - NON-RESIDENT - ACTIVE SPOKANE GENERAL BUSINESS - NON-RESIDENT #T12023478BUS - ACTIVE QUINCY GENERAL BUSINESS - NON-RESIDENT - ACTIVE SNOHOMISH GENERAL BUSINESS - NON-RESIDENT #21712 - ACTIVE TUKWILA GENERAL BUSINESS - NON-RESIDENT - ACTIVE BURLINGTON GENERAL BUSINESS - NON-RESIDENT #9942 - ACTIVE EDMONDS GENERAL BUSINESS - NON-RESIDENT #NR-026761 - ACTIVE MOSES LAKE GENERAL BUSINESS - NON-RESIDENT #BUS2008-00239 - ACTIVE SEATAC GENERAL BUSINESS - NON-RESIDENT - ACTIVE TENINO GENERAL BUSINESS - NON-RESIDENT - ACTIVE MERCER ISLAND GENERAL BUSINESS - NON-RESIDENT #20363 - ACTIVE UBI: 600498022 001 0001 PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE TAX REGISTRATION - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE Expires: May 31, 2024 Profit Corporation PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 Unified Business ID #: 600498022 Business ID #: 001 Location: 0001 Expires: May 31, 2024 Issue Date: Jun 23, 2023 CITY/COUNTY ENDORSEMENTS: FEDERAL WAY GENERAL BUSINESS - NON-RESIDENT (EXPIRES 3/31/2024) - ACTIVE WENATCHEE GENERAL BUSINESS - NON-RESIDENT #000172 - ACTIVE LYNNWOOD GENERAL BUSINESS - NON-RESIDENT - ACTIVE MOUNTLAKE TERRACE GENERAL BUSINESS - NON-RESIDENT - ACTIVE BREWSTER GENERAL BUSINESS - NON-RESIDENT - ACTIVE YAKIMA GENERAL BUSINESS - NON-RESIDENT - ACTIVE UNION GAP GENERAL BUSINESS - NON-RESIDENT (EXPIRES 3/31/2024) - ACTIVE SOUTH BEND GENERAL BUSINESS - NON-RESIDENT #20-429 - ACTIVE BURIEN GENERAL BUSINESS - NON-RESIDENT #08008 - ACTIVE RAYMOND GENERAL BUSINESS - NON-RESIDENT #414.2 - ACTIVE FERNDALE GENERAL BUSINESS - NON-RESIDENT #18058 - ACTIVE COLVILLE GENERAL BUSINESS - NON-RESIDENT #026630.0 - ACTIVE WHITE SALMON GENERAL BUSINESS - NON-RESIDENT #6461 - ACTIVE OCEAN SHORES GENERAL BUSINESS - NON-RESIDENT #23621 - ACTIVE HOQUIAM GENERAL BUSINESS - NON-RESIDENT #601766 - ACTIVE REDMOND GENERAL BUSINESS - NON-RESIDENT #RED08-000155 - ACTIVE WESTPORT GENERAL BUSINESS - NON-RESIDENT #15995 - ACTIVE ABERDEEN GENERAL BUSINESS - NON-RESIDENT #215275 - ACTIVE MONTESANO GENERAL BUSINESS - NON-RESIDENT #7851 - ACTIVE UBI: 600498022 001 0001 PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE TAX REGISTRATION - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE Expires: May 31, 2024 Profit Corporation PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 Unified Business ID #: 600498022 Business ID #: 001 Location: 0001 Expires: May 31, 2024 Issue Date: Jun 23, 2023 DUTIES OF MINORS: Ages 16-17: Cleaning, painting, office administration. *MINOR MUST BE SUPERVISED BY A RESPONSIBLE ADULT IF WORKING PAST 8:00 P.M.* CITY/COUNTY ENDORSEMENTS: BREMERTON GENERAL BUSINESS - NON-RESIDENT #21086 - ACTIVE ARLINGTON GENERAL BUSINESS - NON-RESIDENT (EXPIRES 6/30/2024) - ACTIVE PACIFIC GENERAL BUSINESS - NON-RESIDENT - ACTIVE BENTON CITY GENERAL BUSINESS - NON-RESIDENT #3811 - ACTIVE WOODLAND GENERAL BUSINESS - NON-RESIDENT - ACTIVE OAK HARBOR GENERAL BUSINESS - NON-RESIDENT #BL-001848 - ACTIVE BOTHELL GENERAL BUSINESS - NON-RESIDENT #3515 - ACTIVE AUBURN GENERAL BUSINESS - NON-RESIDENT #BUS-23074 - ACTIVE FRANKLIN COUNTY GENERAL BUSINESS - NON-RESIDENT #0142 (EXPIRES 12/31/2023) - ACTIVE LICENSING RESTRICTIONS: Aberdeen city license valid until canceled by either party. It is the business's responsibility to comply with minor work permit requirements. See WAC 296-125-030 and WAC 296-125-033 for Non-Agricultural and WAC 296-131-125 for Agricultural guidelines and restricted activities. No person, or business, or those under their control, shall cause or allow the discharge of unauthorized pollutants (e.g. chemicals, oils, detergents, or wastewater) into a City of Redmond storm water drainage system, surface water UBI: 600498022 001 0001 PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE TAX REGISTRATION - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE Expires: May 31, 2024 Profit Corporation PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 Unified Business ID #: 600498022 Business ID #: 001 Location: 0001 Expires: May 31, 2024 Issue Date: Jun 23, 2023 bodies or groundwater. Occupations involving exposure to substances which are carcinogenic, corrosive, highly toxic, toxic sensitizers, or that cause reproductive health effects or irreversible end organ damage is prohibited for minors under 18. WAC 296-125-030(25) UBI: 600498022 001 0001 PACIFIC MOBILE STRUCTURES, INC. 1554 BISHOP RD CHEHALIS WA 98532-8710 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE MINOR WORK PERMIT - ACTIVE TAX REGISTRATION - ACTIVE MISCELLANEOUS VEHICLE DEALER #06901 - ACTIVE KELSO GENERAL BUSINESS - NON-RESIDENT #A040656 - ACTIVE MOUNT VERNON GENERAL BUSINESS - NON-RESIDENT - ACTIVE BATTLE GROUND GENERAL BUSINESS - NON-RESIDENT - ACTIVE Expires: May 31, 2024 IMPORTANT! PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE POSTING THIS LICENSE General Information Post this Business License in a visible location at your place of business. If you were issued a Business License previously, destroy the old one and post this one in its place. Login to My DOR at dor.wa.gov if you need to make changes to your business name, location, mailing address, telephone number, or business ownership. Telephone: 360-705-6741 Endorsements All endorsements should be renewed by the expiration date that appears on the front of this license to avoid any late fees. If there is no expiration date, the endorsements remain active as long as you continue required reporting. Tax Registration, Unemployment Insurance, and Industrial Insurance endorsements require you to submit periodic reports. Each agency will send you the necessary reporting forms and instructions. For assistance or to request this document in an alternate format, visit http://business.wa.gov/BLS or call (360) 705-6741. Teletype (TTY) users may use the Washington Relay Service by calling 711. BLS-700-107 (07/27/20) INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE National Union Fire Ins Co of Pitts, PA Navigators Specialty Insurance Co. New Hampshire Insurance Company Great American E & S Insurance Company 7/20/2023 USI Insurance Services NW 601 Union St. Suite 1000 Seattle, WA 98101 206 441-6300 Joy Arakaki 206 731-1200 joy.arakaki@usi.com Pacific Mobile Structures Inc PO Box 1404 Chehalis, WA 98532 19445 36056 23841 37532 A X X X X X 9566289 06/01/2023 06/01/2024 2,000,000 500,000 25,000 2,000,000 4,000,000 4,000,000 A X X X 5717955 06/01/2023 06/01/2024 2,000,000 B X X X X SE23EXCZ080A8IC 06/01/2023 06/01/2024 4,000,000 4,000,000 C Y X 014195905 (AOS-Incl Stop Gap) 014195906 (CA Only) 06/01/2023 06/01/2024 X 2,000,000 2,000,000 2,000,000 D Pollution Professional Combined Policy PCME69239402 06/01/2023 06/01/2024 2M Occ/2M Agg/25K Ded 2M Occ/2M Agg/25K Ded Policy Agg: 2M The General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to City of Arlington only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the named insured. City of Arlington 18204 59th Ave NE Arlington, WA 98223 1 of 1 #S40885218/M40857453 PACIFMOB2Client#: 1575954 PIVZP 1 of 1 #S40885218/M40857453 This page has been left blank intentionally. CG 20 10 12 19 Insurance Services Office, Inc., 2018 Page 1 of POLICY NUMBER: GL 956-62-89 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 2 of Insurance Services Office, Inc., 2018 CG 20 10 12 19 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. POLICY NUMBER: GL 956-62-89 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Any person or organization whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: GL 956-62-89 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: GL 956-62-89 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Pursuant to applicable written contract or agreement you enter into. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 Insurance Services Office, Inc., 2018 Page 1 of 1 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 86681 (9/04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT # AMENDMENT OF LIMITS OF INSURANCE (Per Project or Per Location Aggregate Limit) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM I. Your policy is amended to include either a Per Project General Aggregate Limit, a Per Location General Aggregate Limit or a Per Project and Per Location General Aggregate Limit. Please select only one of the following: [ X ] Per Project General Aggregate Limit $2,000,000 [ ] Per Location General Aggregate Limit $____________ [ ] Per Project and Per Location General Aggregate Limit $____________ IF NEITHER OF THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. IF MORE THAN ONE OF THE THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. II. SECTION III – LIMITS OF INSURANCE, is amended to include the following: 1. The Limits of Insurance and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or “suits” brought; or c. Persons or organizations making claims or bringing “suits”. 2. The General Aggregate Limit is the most we will pay for the sum of : a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of “bodily injury” or “property damage” included in the products-completed operations hazard”; and c. Damages under Coverage B. 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of “bodily injury” and “property damage” included in the “products- completed operations hazard”. 4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all “personal and advertising injury” sustained by any one person or organization. Policy No. GL 956-62-89 issued to PACIFIC MOBILE STRUCTURES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA 86681 (9/04) 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all “bodily injury” and “property damage” arising out of any one “occurrence”. 6. Subject to 5. above, the Damage to Premises Rented To You Limit is the most we will pay under Coverage A because of “property damage” to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of “bodily injury” sustained by any one person. 8. Subject to 2., 4., 5., 6., and/or 7. above, the Per Project Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and c. Medical Expenses under Coverage C arising out of any single Project described above. 9. Subject to 2., 4., 5., 6., and/or 7. above, the Per Location Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and c. Medical expenses under Coverage C arising out of the any single Location described above. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. III. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by the Limits of Insurance set forth below. Limits of Insurance General Aggregate Limit $ 10,000,000 Each Occurrence Limit $ 1,000,000 Products-Completed Operations Aggregate Limit $ 2,000,000 Personal & Advertising Injury Limit $ 1,000,000 Damage to Premises Rented to You $ 500,000 Medical Expense Limit $ 25,000 Per Project General Aggregate Limit, Per Location $ 2,000,000_________ General Aggregate Limit or Per Project and Per Location General Aggregate Limit 86681 (9/04) IV. SECTION V – DEFINITIONS, is amended to include the following: 23. “Location” means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway, or right-of-way railroad. All other terms and conditions of this policy remain the same. Authorized Representative ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO". I. SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. AUTHORIZED REPRESENTATIVE 87950 (9/14) Page 1 of 1 Policy No. CA 571-79-55 issued to PACIFIC MOBILE STRUCTURES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. 74445 (10/99) Policy No. CA 571-79-55 issued to PACIFIC MOBILE STRUCTURES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA ENDORSEMENT 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: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or "loss" if: (1) The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident" or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. 62897 (6/95) AUTHORIZED REPRESENTATIVE Policy No. CA 571-79-55 issued to PACIFIC MOBILE STRUCTURES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA This page has been left blank intentionally. W AIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following " attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). Policy No. WC 014-19-5905 Issued to PACIFIC MOBILE STRUCTURES, INC. By NEW HAMPSHIRE INSURANCE COMPANY We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Tennessee, Texas, Utah, or Washington. This form is not applicable in Missouri when there is a construction code on the policy and there is Missouri premium or exposure. WC 00 03 13 (Ed. 04/84) Countersigned by Authorized Representative BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OT HERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following " attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). Issued to PACIFIC MOBILE STRUCTURES, INC. By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written c ontract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2% of the total estimated workers c ompensation premium for this policy. WC 04 03 61 Countersigned by (Ed. 11/90) Authorized Representative Policy No. WC 014-19-5906 This page has been left blank intentionally. NAV-EXC-348A (01/11)Page 1 of 1Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. COMMERCIAL EXCESS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS OTHER INSURANCE PRIMARY AND NON-CONTRIBUTING This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART SCHEDULE When required by written contract executed before the "loss." A. Section IV - Conditions, 9. Other Insurance is deleted and replaced by the following: 9. This insurance is excess over any other insurance available to the insured except: a. insurance that is purchased specifically to apply in excess of this policy; or b. insurance available to the person or organization shown in the Schedule of this endorsement as an additional insured on the “controlling underlying insurance.” B. When this insurance applies on a primary and non-contributing basis, the Limits of Insurance available for the additional insured will be the lesser of: 1. the amounts shown in item 3 of the Declarations of this policy; or 2. the amount of insurance you are required to provide the additional insured in the written contract or agreement. All other terms of the policy remain unchanged. SE23EXCZ080A8IC NAV-ECD-6012 (01/11)Page 1 of 1Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION SCHEDULE Name of Person or Organization: As required by written contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to SECTION IV - CONDITIONS, 13. Transfer of Rights of Recovery Against Others. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or “your work” done under a contract with that person or organization. This waiver applies only to the person or organization shown in the Schedule above. All other terms of the policy remain unchanged. SE23EXCZ080A8IC NAV-EXC-001 (04/10) Page 1 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. Commercial Excess Liability Coverage Part Various provisions of this policy restrict coverage. Read the entire policy carefully to determine your rights, duties and what is and is not covered. Throughout the policy the words “you” and “your” refer to the Named Insured. The words “we,” “us” and “our” refer to the company providing this insurance. The word “insured” means any other person or organization qualifying as such under SECTION II – WHO IS AN INSURED. Other words and phrases that appear in quotations in this policy have special meanings. Refer to SECTION V - DEFINITIONS. SECTION I – COVERAGE Insuring Agreement Excess Liability We will pay on behalf of the insured and in excess of “underlying limits” those sums the insured becomes legally obligated to pay as damages for “loss” to which this insurance applies. This insurance applies only if: 1. a. the “loss” is caused by an “event” that takes place in the coverage territory; b. the “loss” occurs during the “policy period;” and c. the “controlling underlying insurance” applies to the “loss.” If an aggregate limit of “controlling underlying insurance” is exhausted by the payment of judgments or settlements to which this insurance applies, or would have applied but for the amount of the damages, this insurance will apply in place of the “controlling underlying insurance” until we have paid our applicable Limits of Insurance. 2. When paragraph 2. above applies, ending the “controlling underlying insurance” obligations to investigate and settle claims or defend suits against the insured, we have the right and duty to investigate claims and defend suits which seek damages to which this insurance applies. Our right and duty to defend end when we have paid our applicable Limits of Insurance. 3. When paragraph 2. above does not apply, we have the right, but not the duty, to participate in the investigation or settlement of any claim or the defense of any suit against any insured. 4. We have the right, at our discretion, to settle any claim to which this insurance applies. 5. As respects paragraphs 3. and 4. above, “defense expenses” we incur in the investigation of any claim or defense of any suit will be paid in addition to the Limits of Insurance except when such costs reduce the limits of “controlling underlying insurance,” in which case they will reduce our Limits of Insurance. 6. The amount we pay is limited. See SECTION III – LIMITS OF INSURANCE. 7. A. 1. SE23EXCZ080A8IC NAV-EXC-001 (04/10) Page 2 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. However, in no case will coverage be excluded by the “controlling underlying insurance” and not excluded by this policy. This insurance does not apply to any liability: to which ”controlling underlying insurance” does not apply; 1. for which coverage is provided by “controlling underlying insurance” at limits less than the limits of insurance applicable to other coverage provided by the “controlling underlying insurance” and less than “underlying limits;” 2. for “loss” which commenced prior to this “policy period,” whether or not such “loss” continues, progresses, changes or resumes during this “policy period;” 3. for damage to property you own, rent or occupy, including any costs or expenses incurred by you or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including the prevention of injury to a person or damage to another’s property; 4. for damage to personal property in the care, custody or control of any insured; 5. arising out of any “aircraft products;” 6. arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of “asbestos;” 7. arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of “fungi” or bacteria; 8. arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of “silica” or “silica related dust;” 9. arising out of any “employment practices” of any insured; 10. arising out of: 11. war, including undeclared or civil war; a. warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or b. c. insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these; imposed under: 12. an uninsured or underinsured motorist, uninsured or underinsured boater, Medical Payments, Personal Injury Protection, No-Fault or any similar law; a. a workers compensation, disability benefits, unemployment compensation or any similar law; b. c. the Employee Retirement Income Security Act of 1974, any amendments thereto or any similar law. Exclusions The EXCLUSIONS sections of the “controlling underlying insurance” are made part of this policy. If an inconsistency or contradiction exists between an Exclusion of this policy and an Exclusion of the “controlling underlying insurance” the Exclusion of this policy will apply. 2. NAV-EXC-001 (04/10) Page 3 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. SECTION III – LIMITS OF INSURANCE The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of insureds, claims made or suits brought, or persons or organizations making claims or bringing suits. The General Aggregate Limit is the most we will pay for the sum of all damages to which this insurance applies, except: 1. damages because of bodily injury or property damage included within any applicable products-completed operations hazard; or a. damages arising out of the ownership, operation, maintenance or use of an automobile; b. The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of all damages included within any applicable products-completed operations hazard; 2. Subject to paragraphs 1. and 2. above, the Each Event Limit is the most we will pay for all damages that arise out of any one “event.” 3. SECTION IV – CONDITIONS The CONDITIONS sections of the “controlling underlying insurance” are made part of this policy. If an inconsistency or contradiction exists between the Conditions of this policy and the Conditions of the “controlling underlying insurance,” the Conditions of this policy will apply. Appeals At our discretion we may appeal any judgment which would result in a payment under this policy. When we do appeal, we will pay all costs associated with the appeal in addition to the Limits of Insurance. Any such appeal will not increase our Limits of Insurance. 1. Bankruptcy or Insolvency Bankruptcy or insolvency of the insured or the insured’s estate will not relieve us of our obligations under this policy. Bankruptcy or insolvency of any company providing “controlling underlying insurance” will not reduce the “underlying limits” or increase our obligations under this policy. We will not be required to drop down or replace “controlling underlying insurance.” Cancellation The first Named Insured may cancel this policy at any time by providing us advanced written notice of the cancellation date. We may cancel this policy at any time by providing the first Named Insured written notice of cancellation: i. at least 10 days in advance if we cancel for non-payment of premium; or ii. at least 30 days in advance if we cancel for any other reason: 2. 3. a. b. SECTION II – WHO IS AN INSURED The WHO IS AN INSURED section of the “controlling underlying insurance” is made part of this policy. Any person or organization that is an insured in “controlling underlying insurance” is an insured in this policy to the same extent. NAV-EXC-001 (04/10) Page 4 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. Non-Renewal We are not obligated to renew this policy. However, should we decide not to renew, we will provide the first Named Insured written notice of our decision at least 30 days prior to the expiration date shown in the Declarations. We will not restrict the terms or increase premium of this policy at renewal unless we have given the first Named Insured at least 30 days advanced notice of any such changes. However, no notice will be provided or required if a restriction in this policy results from a restriction applicable to “controlling underlying insurance.” The first Named Insured may non-renew this policy by: i. providing advance written notice to us; ii. rejecting our offer to renew; or iii. failing to reply to our offer to renew. Proof of mailing will be proof of notice. Changes This policy contains all of the agreements between you and us. This policy may only be changed by endorsements we issue. Duties When There is an “Event,” Claim or Suit You must see to it that we and any other insurers who could provide coverage are notified as soon as practicable of any “event” which may be reasonably expected to result in a claim under this policy. To the extent possible, notice should include: i. how, when and where the “event” took place; ii. the names and addresses of any injured persons and witnesses; and iii. the nature and location of any injury or damage arising out of the “event.” If a claim is made or suit is brought against any insured which may be reasonably expected to result in a claim under this policy, you must: i. immediately record the specifics of the claim or suit and the date received; and ii. notify us, and any other insurers who could provide coverage, as soon as practicable. c. You and any other involved insured must: i. immediately send us, and any other insurers who could provide coverage, copies of any demands, notices, summonses or legal papers received in connection with a claim or suit which may be reasonably expected to result in a claim under this policy; ii. authorize us to obtain records and other information; iii. cooperate with us in the investigation or settlement of the claim, issues relating to coverage under this policy or defense against the suit; and iv. assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of the injury or damage to which this insurance may apply. 4. a. b. c. 5. 6. a. b. c. If the “controlling underlying insurance” is cancelled for any reason, this policy is also cancelled. Reinstatement of the “controlling underlying insurance” does not reinstate this policy unless reinstatement is endorsed hereon. Return premium, if any, will be calculated per Condition 11. Premium. Proof of mailing will be proof of notice. NAV-EXC-001 (04/10) Page 5 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. Maintenance of Controlling Underlying Insurance During the “policy period” you must maintain “controlling underlying insurance” with “underlying limits” at least equal to the amounts shown in the Declarations. The “underlying limits” must be unimpaired at the beginning of this “policy period.” If you fail to maintain the “controlling underlying insurance” this policy will be invalid. If you fail to maintain “underlying limits,” we will only be liable to the extent we would have been liable had you maintained the “underlying limits.” Reduction of “underlying limits” by the payment of judgments or settlements for “loss” to which this insurance applies, or would have applied but for the amount of the damages, will not be considered a failure to maintain “underlying limits.” 8. Other Insurance This insurance is excess over any insurance available to the insured except insurance purchased specifically to apply in excess of this policy. 9. Payment of Damages When the amount of damages payable under this policy has been determined by final judgment or a written settlement agreement between the claimant and us, we will pay that amount, up to our applicable Limits of Insurance, after the “controlling underlying insurance” or the insured has paid the full amount of the “underlying limits.” 10. Premium The Premium shown in the Declarations is the premium for the coverage we provide for the “policy period.” The first Named Insured is responsible for the payment of all premiums under this policy. If this policy is cancelled prior to its expiration date return premium will be calculated as follows: 11. if cancelled by us: [{(Premium) – (Minimum Earned Premium)} x (Pro Rata factor)] if cancelled by you: [{(Premium) – (Minimum Earned Premium)} x {(Pro Rata factor) x (.90)}]. Separation of Insureds Except with respect to the Limits of Insurance and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: 12. as if each Named Insured were the only Named Insured; and separately to each insured against whom claim is made or suit is brought. Transfer of Rights of Recovery Against Others If an insured has rights to recover all or part of any payment we have made under this insurance, the insured must preserve those rights and, at our request, pursue or transfer those rights to us. The insured must do nothing after an “event” to impair them. 13. a. b. a. b. Legal Action Against Us No person or organization has a right under this insurance: to join us as a party or otherwise bring us into a suit asking for damages from an insured; or to sue us on this insurance unless all of its terms have been fully complied with. 7. a. b. No insured will, except at that insured’s own cost, voluntarily make a payment, assume any obligation or incur any expense, other than first aid, without our consent. Notice to us may be sent to our address shown in the Declarations. d. NAV-EXC-001 (04/10) Page 6 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. and we are prevented by law from paying such damages on behalf of the insured, we will reimburse the insured, in U.S currency at the prevailing exchange rate at the time the damages were paid, for such damages. SECTION V – DEFINITIONS The DEFINITIONS sections of the “controlling underlying insurance” are made part of this policy, and apply to words or phrases used in this policy provided always that words or phrases in quotations in this policy will have the meaning given them in this policy. “Aircraft products” means: an aircraft; ground control or support equipment; or any article, component or device made, sold, licensed, handled or distributed by any insured that is used to achieve, control or maintain flight or landing of an aircraft. “Asbestos” means the mineral in any form. “Controlling underlying insurance” means the policy listed in the Schedule of Underlying Insurance shown in the Declarations, or its renewal or replacement, which applies to the “loss,” or would have applied but for: an exclusion in that policy; or the exhaustion or erosion of an aggregate limit of insurance; If more than one policy is listed in the Schedule, the “controlling underlying insurance” is the policy which applies to the “loss” or would have applied but for the reasons a. or b. listed above. “Defense expenses” means expenses we incur to investigate a claim or defend a suit. Defense expenses include interest which accrues on our portion of a judgment, after entry of that judgment and after the insured or any underlying insurer has paid the full amount of their portion of the judgment but before we have paid, offered to pay or deposited in the court the part of the judgment that is within our applicable Limits of Insurance. “Employment practices” means: a. b. c. a. b. Reformation of Underlying If the “controlling underlying insurance” is reformed after an “event” to provide coverage for a “loss,” the terms of such reformation do not apply to this policy. 14. When we Defend When we have a duty to defend an insured, the insured will cooperate with us in the transfer of the defense to counsel of our choosing. If the law of the governing jurisdiction permits an insured to select their own counsel to be paid for by us, we shall only be liable for the reasonable and necessary defense costs of one law firm per insured at rates customarily paid by us for the defense of similar claims in the jurisdiction where the claim is pending. 15. Claims outside the U.S.A, it’s Territories, Possessions or Canada When we have the duty to defend an insured and are prevented by law or otherwise from doing so, we will reimburse the insured for any reasonable and necessary expenses incurred in the defense of a suit to which this insurance applies. If the insured becomes legally obligated to pay damages to which this insurance applies 16. NAV-EXC-001 (04/10) Page 7 of 7 Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. “Fungi” means any type or form of fungus, including mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. But “fungi” does not include mushrooms cultivated for human consumption. “Loss” means bodily injury, property damage, personal and advertising injury or other loss defined by and to which the “controlling underlying insurance” applies. “Policy period” means the period of time between the effective date shown in the Declarations and the earlier of the expiration date shown in the Declarations or the expiration date shown in an endorsement to this policy. “Silica” means silicon dioxide, occurring in crystalline, amorphous or impure forms, silica particles, silica dust or silica compounds. “Silica related dust” means a mixture or combination of silica and other dust particles. “Underlying limits” means the amounts shown in the Declarations as the minimum limits of insurance to be provided by “controlling underlying insurance.” In Witness Whereof, the issuing Company has caused this policy to be signed officially below, and countersigned on the Declarations page by a duly authorized representative of said Company. Stanley A. Galanski Jeff L. Saunders President Vice President dismissal, discharge or termination of employment, whether actual, constructive or retaliatory; failure or refusal to hire or promote; discipline, demotion, coercion or retaliatory treatment; failure to grant tenure; negligent employment evaluation; e. sexual or other workplace harassment, including quid pro quo and hostile work environment; f. employment discrimination; g. invasion of privacy, violation of employment related civil rights, employment related libel, slander or defamation; creating or enforcing or failing to create or enforce employment related policies or procedures; or i. actual or alleged violations of the Family and Medical Leave Act of 1993 or its amendments. j. “Event” means an accident, incident, occurrence, offense, wrongful act or other “loss” causing “event” defined by and to which the “controlling underlying insurance” applies. a. b. c. d. h. This page has been left blank intentionally.