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BLD1992-0426 LEGAL DOCS- -- 1�5-7. - 75A`2Z ZC - No EXCISE TAX REQUIRED I11111IN1111111111111111111111118111I 2pp06FQ g71267 4 PGS IFEB 0 6 2006 0NO MISH 4: i3 1 gg3� 00 INI SnahQaUSh County TR8WC( SNOHOMISH COUNT RASHINGTON BOB oaNt ....... •; :' gy BQB OANTINI 1 •-CITY CLERK CITY OF EDMONDS 11tFriAXENVe N(Z• 0KN NDS, WA 98020 MUTUAL GRANT OF EASEMENT X. PHIS AGREED'FINT, made and entered into by and between HARRISON JEWELL... f'i rs.t-'Ipirtj�,.,..end JEAN C. RIGGLE, second party, each of the partie's:' agree for themselves, their heirs, executors, administrators.•"nd assigns. Leeja I ' Sea 5, TWl) a-7, C-1 W I T N-9 s"i E 'F H: ;•.PaRC�� No, Do5131oagoc 5�� WHEREAS'-, 'th'@ p'ar>`l"e§•: hereto are owners of adjoining real estate here inbelb�.•`de$dribed and located in EDMONDS, SNOHOMISH County, Washingtpn;and•, '• WHEREAS, the part•ies,•'ha.Ve a•%common boundary and desire to share the use of g. common``�asement for purposes of providing drainage and utilities:'to`'thekY respective properties, and WHEREAS, the partieq titf'hing to formalize the common usage by a Grant of Easement, one to the p&r.,.. fpr purposes of a common drainage and utility easement, NOW, THEREFORE, it is hereby..."i•eecl:'as follows: 1. First party is the owner of':e"ft711owing described real estate, to wit: see Exhibit "A" attached 2. Second party is the owner obt-he'fbllowii49 described real estate, to wit: see Exhibit "B" attached 3. .First party hereby grants to "the.:6ec."Z1:party, her successors and assigns a nonexclusive easement:*1.over,:•'under and across the real estate owned by the first party* and'd6scx'ibed in paragraph 1 above, for purposes of drainage and utility -access to second party's property described in paragraph'•`2,:•above,, dnd existing structures thereon. This easement is intenciq,, tQ:bene'fit and be appurtenant to second party's property and to rs}n wtt-i'the . land, and includes the right of ingress and egress to serv.--Ice•.ibee drainage and utilities. 4. Second party hereby grants to the first party,'''ha . successors and assigns a nonexclusive easement over, under 'end' •i. MUTUAL GRANT OF EASEMENT THIS AGREEMENT, made and entered into by and between HARRISON JEWEIIP first party, and JEAN C. RIGGLE, second party, each of the ' pi�•Y ies egreeing for themselves, their heirs, executors, alki.jiistrators;,end assigns. W I:T'NE-SSETH. WH RE�,SM1 ttie 'parties hereto are owners of adjoining real estate',; iiere•fnbelpw."described and located in EDMONDS, SNOHOMISH County, Was.hfngt'on;.and WHEREB, ttie••••garties have a common boundary and desire to share the use;'of-'" dommon easement for purposes of providing drainage and tktilizi' ;•tq:their respective properties, and WHEREAS, th'e g4rLes•wishing to formalize the common usage by a Grant of Easemebtr-`�oae'-to'the other, for purposes of a common drainage and utility' easement; NOW, THEREFORE,, It is`hr-reby'agreed as follows: 1. First party zS:.the .owner of the following described real estate, to wit: see Exhibit "A" attached . 2. Second party is the'Vwrier of t" following described real estate, to wit: - see Exhibit "B" attached 3. First party hereby grants'•• to .khe second party, her successors and assigns a nonexclusiveeasemFni. over, under and across the real estate owned by the first party and described in paragraph 1 above, for purposes of drairiAcge,.brsd•`utA ity access to second party's property described in pafagFdpta"2`, above, and existing structures thereon. This easement 3:9•;intoiid4i1%to benefit and be appurtenant to second party Is property 'di5d to, -•run `•with the land, and includes the right of ingress and egress,ttb service the drainage and utilities. 4. Second party hereby grants to the first.Aea y, 'his successors and assigns a nonexclusive easement over,;`urf4 r.-`and �. commission State of Wa�hlhgton. ! � `'' t ST4'rE-"OF WXSHINGTON ) ) ss. COONTT* OF. • XiNG ) I ce'rtA fy.-*t1zAt''j: know or have satisfactory evidence that Jean C. Riggie pigned thi6.instrument and acknowledged it to be her free and valu.AaZy' act '.-t:6r the uses and purposes mentioned -in this instrument,--'* DATED: 'Jur;e 7.. '-NOTARY PUBLIC in and for the State of Washington. O�y A j�� '� Commission Expires 1 .t�ptARy �t 3 •x �� < L1 NO EXCISE TAX -- REQUIRED iFEB 0 6 2006 BOB DANTINI• Snohomish Caumq TieaS= Bq BOB DANTINI 1111A1fill I111lull III IN11111M111111111111111 Q2F60 2000604 133 m gg337 6 QGS y�H4NISH COUNi�, NSHINGTON CITY OF;EDMONDS 121 STH AKENU�440... EDMONDS, WA."9800 _ .•••••.•.. 'GRANT OF EASEMENT FOR IGI2ESS •IND; ;)~GISS DURING CONSTRUCTION 1. EFFECTIVE DAT2,:' ; '- '•J'UNE`•. , 1991. 2. PARTIES: A. HARRISON JEWELIr•'(owner--"of burdened property) � C.0 arf-pr _ • B. JEAN C. RIGGLE',(cyrier of benefited property) 3. PROPERTIES: Le -la 1 : ' 5, T..WN all, R .�J 1�aC�P � Ata. O0$13, 0 0$00602. BENEFITED PROPERTIES: A. SEE EXHIBIT "B" ATTALHED••I!ERE.Tb- BURDENED• B. SEE EXHIBIT "A" ATTACHED iiERET6 4. GRANT OF EASEMENT HARRISON JEWELL, as owner of the burrdened- property, hereby grants _ to JEAN C. RIGGLE, her heirs, sticcesrors and assigns, as owners of the benefited property, a non=eitclusive; easement for ingress and egress over and across theSw-20 Meet of the above -described burdened property for the purpos,P,:•bf ,access during the course of construction of improvements•....upon;"the'.,benefited property. This easement is granted on the condition, ;rid..zubjeci to the owner of the benefited property: a) Protecting the burdened property and any.:impovements thereon from damage during the course of constructibn.: b) Saving and holding harmless the owner ofg bu�edgned property from any and all claims and/or liens by third Parti14p. c) Restoring the area of the easement to the con r%pR .xt was in immediately prior to the commencement of construct-'oz;.:� 1 d) Exerting his best efforts to conclude all construction :•act•j.vity in an expeditious manner. 5': $NFORCEABILITY: :Thp Easement hereby granted to the owner of the benefited prbpttrty`above described may be enforced by the present as well as ,.eho future owners of the above described benefited property. 6. �M SID6AT3:69 ' A13 partie's agree that each has received good and valuable consider$tio'n•'in atiutual benefits as a result of having entered into this agreemeint: `. •:......•••• 7. SIGNATURES: 8. ACVNOWLEDGEMENTS:...: STATE OF WASHINGTON ) ss•. COUNTY OF KING ) I hereby certify that I kgow Qr h'Ave satisfactory evidence that JEAN C. RIGGLE has signed.•ihis,instrument and acknowledged to be HER free and voluntary act for''thp''usbs and purposes mentioned in the instrument. DATED this �_ day of.:�"�ne .• ' ••.• 1991. OT LVC'' in: sand for the State of Washingtotsc Commission Expires.;,., %t k -4Y ~'*114 SOff+`"°`;�.� 11 tj••his best efforts to conclude all construction activity 'tn:'an,.4xpeditious manner. 5. ,E,NFORCE' 8{, YL•TTY-; , `• The Easemient hereby :.�rhnted to the owner of the benefited property aboveenforced by the present as well as the future owners of the above described benefited property. 6. CONSIDERATION: All parties agree t�iat; each has ..received good and valuable consideration in mutual bdnefits as %-,;eiult of having entered into this agreement. 7. SIGNATURES: 8. AC OWLEDGEMENTS: STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) I hereby certify that I know or have ga ziactory evidence that JEAN C. RIGGLE has signed this instrument dhd•`ackhowledged to be HER free and voluntary act for the uses and'P5irposet,mentioned in the instrument. DATED this 7 day of 'NOTARY PUBLIC in and for $he, tat of Washington. commission Expires: i '�� 0#1* j, �O ti uit sZ.fJo v:Yr.# 6. ' 'i s'TAT f►•C . STATE`. -.OF WASHINGTON ) ) ss. ...-COUNTY '. OF KING ) . 7 hereby certify that I know or have satisfactory evidence ' th4t HISbN JEWELL has signed this instrument and acknowledged to be hi p... f"rem:-anc'i 4-pluntary act for the uses and purposes mentioned in 'the ipstrument'.� DATE Q-'th s 7 day of ne 1991. Y�r OTARY PUBLIC in and for the State of WASHINGTON, tJ ATkj ' �i: commission Expires: • �v: ���• NCO %Off'- � •• - L� v o n•� G Vs'1. ••- . r� ����� r off or4%I 3 EXHIBIT "A" The ,North 45•1 feet of Lots 5, Block 28 of the Plat ,df Me'addwdale Beach recorded in volume 5 of Plats, Page.*'*38, records of Snohomish CountA l -" W�Lshi-M-Om. Together with a portion of vaCa►ted.,.7�th 'Avenue West lying adjacent. ' V• EXHIBIT "B" The .s'outh 1-5. feet of Lot 5 plus the vacated streef.-.-=`-Thd North 30 feet of Lot 6 plus vacated" st-Xp-et ! f'.. block 28 of the Plat of Meadowdale `B.e-�-dfl-"recorded in Volume 5 of Plats,`--patje-, 38.;-' records of Snohomish county, Washingt.ob. i. \ CITY CLERK CIVIC CENTER EDMONOS. WA 98020 to COVENANT OF NOTIFICATION AND INDEMNIFICATION/HOLD HARMLESS Under the review procedures established pursuant to the State Building Code, incorporating amendments promulgated by the City of Edmonds, and as a prerequisite to the issuance of a building permit for the construction of a residential structure and Q, attendant facilities, the undersigned OWNERS of property do hereby covenant, stipulate and promise as follows: 1 Description of S J; Va.Property. T11LIIS covenant _ vl notification and indemnification/hold harmless relates to a tract d1 of land at the street address of .3-,9,04 75- 01 VeJ ( insert street address), Edmonds, Snohomish County, Washington and legally described as: /V Lai s; /3br, ' 2S. 2. Notification and Covenant of Notification. The above X referenced site (hereinafter "subject site") lies within an area r which has been identified by the City of Edmonds as having a potential for earth subsidence or landslide hazard. The risks T associated with development of the site have been evaluated by,. technical consultants and engineers engaged by the applicant as a part of the process to obtain a building permit for the subject site. The results of the consultat's,sreEp�r-tsp. evaluations of 01 WSS52079A/0006.040.034 -1- BUILDING WSS/klt 02/08/90 �:y;, , 1992 FEB 9 - "'0 �' ,t�: a 'a (cusi Ii�siUiei the risks associated with development are contained in building permit file number (insert number) on file with the City of Edmonds Building Department. Conditions, limitations, or prohibitions on development may have been imposed in accordance with the recommendations of the consultants in the course of permit issuance. The conditions, limitations, or prohibitions may require ongoing maintenance on the part of any .owner or lessee or may require modifications to the structures and earth stabilization matters in order to address future or anticipated changes in soil or other site conditions. The statements and conditions proposed by the OWNERS' geotechnical engineer, geologist, architect and/or structural engineer are hereby incorporated by reference from the contents of the file as fully as if herein set forth. Any future purchaser, lessee, lender or any other person acquiring or seeking to acquire an interest -in the property is put on notice of the existence of the content of the file and the City urges review of its contents. The file may be reviewed during normal business hours or copies obtained at the Planning Department, City of Edmonds, 505 Bell' Street, Edmonds, Washingtcn 98020. 3. Indemnification and Hold Harmless. The undersigned OWNERS hereby waive any and all liability associated with development, stating that they have fully informed themselves of all risks associated with development of the property and do therefore waive and relinquish any and all' causes of action against the City of Edmonds, its officers, agents and employees WSS52079A/0006.040.034 -2- WSS/klt 02/08/90 2 } VOL. Nip3PAGE j J2 arising from and out of such development. In addition, the OWNERS on behalf of themselves, their successors in interest, heirs and assignees, do hereby promise to indemnify and hold harmless the City of Edmonds, its officers, agents and employees from any loss, claim, liability or damage of any kind or nature to persons or property either on or off the site resulting from or out of earth subsidence or landslide hazard, arising from or out of the issuance of any permit(s) authorizing development of the site, or occurring or arising out of any false, misleading, or inaccurate information provided by the OWNERS, their employees, or professional consultants in the course of issuance of the building permit. 4. Insurance Requirement. In addition to any bonding which may be required during the course of development, the Community Services Director has/has not (strike one) specifically required the maintenance of an insurance policy for public liability coverage in the amount and for the time set forth below in order to provide for the financial responsibilities established through the indemnification and hold harmless agreement above: [insert insurance requirements and time period, if any --if no insurance required., so state.] WSS52079A/0006.040.034 -3- wss/klt 02/08/90 V0L, ti b PAGE 3 l' S. Covenant to Touch and Concern the Land. This covenant of notification and indemnification/hold harmless touches and concerns the subject tract and shall run with the land, binding, obligating and/or inuring to the benefit of future owners, heirs, successors and interests or any other person or entity acquiring an interest in property, as their interest may appear. This provision shall not be interpreted to require a mortgagor or lender to indemnify the City except to the extent of their loss nor to obligate such persons to maintain the insurance above required. DONE this 79- day of Qest & , 1991. OWNER(S) By: By: M STATE OF WASHINGTON ) ) ss: COUNTY OFS) Icertify that I know or have satisfactory evidence that i�� _g signed this instrument and acknowledged' WSS52079A/0006.040.034 -4- WSS/klt 02/08/90 ` "�' it to be (his/+m-r) free and voluntary act for the purposes mentioned in this instrument. DATED this day of , 199(. NOTARY PUBLIC My commission expires: Q - 1— STATE OF WASHINGTON )ss: COUNTY OF ) I certify that I know or have satisfactory evidence that signed this instrument and acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in this instrument. DATED this day of 199_. 6 z NOTARY PUBLIC My commission ex rescue STATE OF WASHINGTON ) �o )ss: • W COUNTY OF ) I certify that I know or have satisfactory evidence that signed this instrument, on.oath stated that (he/she) was authorized to execute the instrument and acknowledged it as the (title) of (name of party on behalf of whom instrument was executed) to be the free and voluntary act of such party for the uses and purposes mentioned in this instrument. DATED this day of , 199_. WSS52079A/0006.040.034 WSS/klt 02/08/90 NOTARY PUBLIC My commission expires: -5- VOL. L" 6 6 S PAGE 10 5 i� I'll, `91 ZK 21 0 z �19 GRANT OF EASEMENT FOR INGRESS AND EGRESS DURING CONSTRUCZ _ : --.A - TY, `. 1. EFFECTIVE DATE: JUNE , 1991. 2. PARTIES: A. HARRISON JEWELL (owner of burdened property) B. JEAN C. RIGGLE (owner of benefited.property) 3. PROPERTIES: BENEFITED PROPERTIES: A. SEE EXHIBIT "B" ATTACHED HERETO BURDENED: B. SEE EXHIBIT "A" ATTACHED HERETO 4. GRANT OF EASEMENT: NO EXCISE TAX REQUIRED JUN 2 c3 10P KI Rs, snohomish oun TreasL r By Deputy HARRISON JEWELL, as owner of the burdened property, hereby grants to JEAN C. RIGGLE, her heirs, successors and assigns, as owners of the benefited property, a non-exclusive easement for ingress and egress over and across theSovlk-�a.0 feet of the above -described burdened property for the purpose of access during the course of construction of improvements upon the benefited property. This easement is granted on the condition, and subject to the owner of the benefited property: a) Protecting the burdened property and any improvements thereon from damage during the course of construction. b) Saving and holding harmless the owner of the burdened property from any and all claims and/or liens by third parties. c) Restoring the area of the easement to the condition it was in immediately prior to the commencement of construction. 1 d) Exerting his best efforts to conclude all construction activity in an expeditious manner. 5. ENFORCEABILITY: The Easement hereby granted to the owner of the benefited property above described may be enforced by the present as well as the future owners of the above described benefited property. 6. CONSIDERATION: All parties agree that each has received good and valuable consideration in mutual benefits as a result of having entered into this agreement. 7. SIGNATURES• C M. STATE OF WASHINGTON ) ss. COUNTY OF KING ) I hereby certify that I know or have satisfactory evidence that JEAN C. RIGGLE has signed this instrument and acknowledged to be HER free and voluntary act for the uses and purposes mentioned in the instrument. DATED this 7_ day of 7L—) n -e, , 1991. 4TY�PUB�LIC in and for the State of Washington. Commission Expires: 2 VOL 2453PM2�'�� ' 44ft STATE OF WASHINGTON ) )ss. COUNTY OF KING ) I hereby certify that I know or have satisfactory evidence that HARRISON JEWELL has signed this instrument and acknowledged to be his free and voluntary act for the uses and purposes mentioned in the instrument. DATED this -- day of 1991. NOTARY PUBLIC in and for the State of WASHINGTON, Commission Expires: 1 ►-fib-`f y 3 06210 4 vas. 2453PAaE255)7 EXHIBIT "A" The North 45 feet of plat of Meadowdale Be of Plats, page 38, County, Washington. of vacated 75th Avenu �L, 0 44 Lots 5, Block 28 of the ach recorded in Volume 5 records of Snohomish Together with a portion e West lying adjacent. voL. 24'a3Pw2'O'O'8 EXHIBIT "B" The south 15 feet of Lot 5 street. The North 30 fee vacated street of block 28 Meadowdale Plats, page Washington. Beach recorded 38, records of plus the vacated t of Lot 6 plus of the Plat of in Volume 5 of Snohomish County, YOl.24J3PAGE25';j9 9 ' 210 44 MUTUAL GRANT OF EASEMENT CITY COPY THIS AGREEMENT, made and entered into by and between HARRISON JEWELL first party, and JEAN C. RIGGLE, second party, each of the parties agreeing for themselves, their heirs, executors, administrators and assigns. W I T N E S S E T H• f�•{ WHEREAS, the parties hereto are owners of adjoining real estate hereinbelow described and located in EDMONDS, SNOHOMISH County, Washington and WHEREAS, the parties have a common boundary and desire to share the use of a common easement for purposes of providing drainage and utilities to their respective properties, and WHEREAS, the parties wishing to formalize the common usage by a Grant of Easement, one to the other, for purposes of a common drainage and utility easement, NOW, THEREFORE, it is hereby agreed as follows: 1. First party is the owner of the following described real estate, to wit: see Exhibit "A" attached 2. Second party is the owner of the following described real estate, to wit: see Exhibit "B" attached 3. First party hereby grants to the second party, her successors and assigns a nonexclusive easement over, under and across the real estate owned by the first party and described in paragraph 1 above, for purposes of drainage and utility access to second party's property described in paragraph 2 above, and existing structures thereon. This easement is intended to benefit and be appurtenant to second party's property and to run with the land, and includes the right of ingress and egress to service the drainage and utilities. 4. Second party hereby grants to the first party, his successors and assigns a nonexclusive easement over, under and NO EXCISE TAX REQUIRED 1 ,JUN20� K SIE , Snohomish unty lreAW161i Ci Deput, 1�1. 2`�e��r�'U��'�® ` 0621043 . across the real estate owned by the second party and described in paragraph 2 above, for purposes of drainage and utility access to first party's property described in paragraph 1 and existing structures thereon. This easement is intended to benefit and be appurtenant to f irst party' s property and to run with the land, and includes the right of ingress and egress to service the drainage and utilities. 5. The easements herein granted are for the purposes of creating adequate sewer and other drainage and utility service common to the real estate owned by both parties hereto, said real estate being above described, and shall be limited to a 20' parcel, that is 10' on either side of the common drain lines. 6. The parties, their successors and assigns shall contribute equally to the expenses of reasonable repair and maintenance to the common drainage and utilities. DATED this day of , 1991. 01 arriso well, irst Party �17a—n C. Riggle, S c nd Party STATE OF WASHINGTON )ss. COUNTY OF KING ) I certify that I know or have satisfactory evidence that Harrison Jewell signed this instrument and acknowledged it to be his free and voluntary act for the uses and purposes mentioned in this instrument. DATED T n ,-1 70 i'? 7.1 2 's h�G . l o62j. 0 4 NOTARY PUBLIC in and for the State of Washington. Commission Expires STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) I certify that I know or have satisfactory evidence that Jean C. Riggle signed this instrument and acknowledged it to be her free and voluntary act for the uses and purposes mentioned •in this instrument. DATED 7,L�h�� % , / 99/ 9TARY PUBLIC in and for the State of Washington. 91 Commission Expires voi. 2 4 5 3 pho[ 2 5 5 2 EXHIBIT "A" The North 45 feet of Lots 5, Block 28 of the plat of Meadowdale Beach recorded in Volume 5 of Plats, page 38, records of Snohomish County, Washington. Together with a portion of vacated 75th Avenue West lying adjacent. x w... -o VOL.2453Pn(2Wb3 EXHIBIT "B" The south 15 feet of Lot 5 plus the vacated street. The, North 30 feet of Lot 6 plus vacated street of block 28 of the Plat of Meadowdale Beach recorded in Volume 5 of Plats, page 38, records of Snohomish County, Washington. Not. 2453pht�2554 lnc.189v CITY OF EDMONDS 121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning • Building • Engineering April 9, 1999 _ Harrison Jewell 15706 75th Place West Edmonds, Washington 98026 RE: Homeowner Insurance Coverage for Meadowdale Development !20¢2l0 . BAR,BARA FAHEY MAYOR As you may recall, development of your home was subject to Edmonds Community Development Code (ECDC) Chapter 19.05.050 which regulated construction and insurance coverage requirements for all designated Meadowdale Landslide Hazard Area development. The purpose of this letter is to inform you that the Edmonds City Council has enacted a change which effects your homeowners policy that was required by this ordinance. If you recall you were required to post a one million dollar homeowner policy in order for your home to be granted final occupancy. Please be advised, the City Council has repealed this requirement effective April 16, 1999. In lieu of this policy the City Council will be holding future public hearings to determine alternate coverage methods to ensure that the intent of ECDC 19.05.050 are still met. Please contact the City Clerk if you are interested in attending these meetings. You may wish to consult your insurance professional to determine the proper amount of insurance coverage necessary to meet your specific needs. Since the insurance requirement is repealed the City no longer requires to be informed of your coverage or be provided with a copy of your current policy. Please feel free to contact me if you have any questions at 771-0220. Thank you, V" A Jeannine L. Graf Building Official • Incorporated August 11, 1890 • Sister City - Hekinan, Japan CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) n 04/28/92 PRODUCER 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 STANLEY T. SCOTT & CO., INC. POLICIES BELOW. 2312 EASTLAKE AVE. E. COMPANIES AFFORDING COVERAGE SEATTLE, WASHIN5TUN 98102 (206) 323-3931 COMPANY A LETTER American States Insurance Co>apany COMPANY B INSURED LETTER WILDING COMPANY C Ronald 0. Snare DBA: Snare Construction LETTER 041-1992 1127 148th St. NE. COMPANY D Arlington, Washington 98223 LETTER COMPANY E LETTER COVERAGES 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. CO TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) OLICY EXPIRATION DATE (MM/DD/YY) LI17�fR ALL IN THOUSANDS A GENERAL LIABILITY GENERAL AGGREGATE $ 2,000 PRODUCTS- COMP/OP AGG. $_ fOOO COMMERCIAL GENERAL LIABILITY 01-AP-059656-9 06/01/91 06/01/92 ] ? CLAIMS MADE OCCUR. PERSONAL & ADV. INJURY $ 1,000 EACH OCCURRENCE $ 1 000 OWNER'S & CONTRACTOR'S PROT. _WASiL,_ST.OP 5AF FIRE DAMAGE (Any one fire) $ 50 MED. EXPENSE (Any one person1 $ 5 AUTOMOBILE LIABILITY COMBINED SINGLE $ A ANY AUTO LIMIT 1,000 ALL OWNED AUTOS 01-AP-059656-9 06/01/91 06/01/92 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS EACH ACCIDENT " $ AND DISEASE -POLICY LIMIT $ EMPLOYERS' LIABILITY DISEASE -EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS The City of Edmonds shall be Additional Insured as respects liability arising out of work performed by the Named Insured RE: construction of a private residence for Mr.& Mrs. Harrison Jewell - constructed at or about: 15716 W. 75th Place, Edmonds, MIA Form C62010 Additional Insured shall apoly CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Attn: Jeanine Graf 10 MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE City of Edmonds LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 250 5th Ave. North LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Edmonds, Washington 9BO20 AUTHORIZED REPRESENTATIVE R. Y. Smith/cd3� ACORD 25-S (7190) ©ACORD CORPORATION 1990 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR . CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Edmonds RE: construction of private 250 5th Ave. North residence - Edmonds, Washington 48020 constructed at or about: 15716 W. 7=th P1. , Edmonds (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 ❑ Harrison Jewell 5301 Leary Ave NW. Seattle, WA 98107 June, 6, 1991 City of Edmonds Building Dept Edmonds, Wa Subject: 10. Bonds and Public Liability Insurance, page 9 submittal check list. Dear Sirs; If you will notify me when the permit is about to be issued, I will provide a bond for $27,741 dollars for the restoration, in case of slide damage during construction. I will also provide you with general public liability in the amount of one million dollars, naming the City as an additional insured. At the present time I have not determined the general contractor, but I realize that the contractor must have public liability insurance naming the City as additional insured before the permit can be issued. Sincerely Yours Harrison Jewell